Authors: Stephanie C DeMasi, Wesley H Self, Neil R Aggarawal, Michael D April, et al.
Journal: Annals of Emergency Medicine, October 2024
Conclusion:
There were no significant differences in first-attempt intubation success or severe complication rates between critically ill adults who received succinylcholine and those who received rocuronium for emergency tracheal intubation. Both neuromuscular blocking agents appear to be equally effective and safe in this population.
Methods:
This was a secondary analysis of data from two multicenter randomized trials. The analysis included critically ill adults undergoing tracheal intubation in an emergency or intensive care setting. Patients were divided into two groups based on the neuromuscular blocking agent received: succinylcholine or rocuronium. The primary outcome was the incidence of successful first-attempt intubation, while the secondary outcome was the incidence of severe complications during intubation. A generalized linear mixed-effects model with prespecified baseline covariates was used to analyze the associations.
Results:
- Total patients analyzed: 2,339 (95.9% of the original 2,440 participants)
- 475 (20.3%) received succinylcholine
- 1,864 (79.7%) received rocuronium
- First-attempt intubation success:
- Succinylcholine group: 375 patients (78.9%)
- Rocuronium group: 1,510 patients (81.0%)
- Adjusted odds ratio: 0.87 (95% CI: 0.65-1.15)
- Severe complications:
- Succinylcholine group: 67 patients (14.1%)
- Rocuronium group: 456 patients (24.5%)
- Adjusted odds ratio: 0.88 (95% CI: 0.62-1.26)