Premium
Comparison of Succinylcholine and Rocuronium for First‐attempt Intubation Success in the Emergency Department
Author(s) -
Patanwala Asad E.,
Stahle Sara A.,
Sakles John C.,
Erstad Brian L.
Publication year - 2011
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.2010.00954.x
Subject(s) - medicine , rocuronium , intubation , interquartile range , anesthesia , laryngoscopy , emergency department , confidence interval , odds ratio , airway management , surgery , psychiatry
ACADEMIC EMERGENCY MEDICINE 2011; 18:11–14 © 2011 by the Society for Academic Emergency Medicine Abstract Objectives: The objective was to determine the effect of paralytic type and dose on first‐attempt rapid sequence intubation (RSI) success in the emergency department (ED). Methods: This was a retrospective evaluation of information collected prospectively in a quality improvement database between July 1, 2007, and October 31, 2008. Information regarding all intubations performed in a tertiary care ED was recorded in this database. All RSI performed using succinylcholine or rocuronium were included. Logistic regression was used to analyze the effect of paralytic type and dosing, as well as age, sex, body mass index, physician experience, device type, and presence of difficult airway predictors on first attempt RSI success. Results: A total of 327 RSI were included in the final analyses. All patients received etomidate as the induction sedative and were successfully intubated. Of these, 113 and 214 intubations were performed using succinylcholine and rocuronium, respectively. The rate of first‐attempt intubation success was similar between the succinylcholine and rocuronium groups (72.6% vs. 72.9%, p = 0.95). Median doses used for succinylcholine and rocuronium were 1.65 mg/kg (interquartile range [IQR] = 1.26–1.95 mg/kg) and 1.19 mg/kg (IQR = 1–1.45 mg/kg), respectively. In the univariate logistic regression analyses, variables predictive of first‐attempt intubation success were laryngeal view (more success if Grade 1 or 2 compared to Grade 3 or 4 of the Cormack‐Lehane classification, odds ratio [OR] = 55.18, 95% confidence interval [CI] = 18.87 to 161.39), intubation device (less success if direct laryngoscopy, OR = 0.57, 95% CI = 0.34 to 0.96), and presence of a difficult airway predictor (OR = 0.55, 95% CI = 0.31 to 0.99). In the multivariate analysis, the only variable predictive of first‐attempt intubation success was laryngeal view. Conclusions: Succinylcholine and rocuronium are equivalent with regard to first‐attempt intubation success in the ED when dosed according to the ranges used in this study.