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Effect of Rocuronium vs Succinylcholine on Endotracheal Intubation Success Rate Among Patients Undergoing
Bertrand Guihard1, Charlotte Chollet-Xémard2, Philippe Lakhnati3
1Department of Emergency, CHU de la Réunion, Allée des Topazes, Saint Denis, Réunion, France.
JAMA
|December 18, 2019
Summary
Rocuronium did not prove to be as effective as succinylcholine for first-attempt tracheal intubation in emergencies. This study found succinylcholine to be superior for successful emergency intubations.
Area of Science:
- Emergency Medicine
- Anesthesiology
- Clinical Trials
Background:
- Rocuronium and succinylcholine are common agents for rapid sequence intubation.
- Comparative efficacy for emergency intubation is not well-established.
- Succinylcholine has known adverse events not seen with rocuronium.
Purpose of the Study:
- To evaluate if rocuronium is noninferior to succinylcholine for tracheal intubation in out-of-hospital emergencies.
- To compare the success rates of first-attempt intubation between rocuronium and succinylcholine.
Main Methods:
- A multicenter, single-blind, noninferiority randomized trial.
- 1248 adult patients requiring out-of-hospital tracheal intubation were randomized.
- Rocuronium (1.2 mg/kg) was compared to succinylcholine (1 mg/kg).
Main Results:
- First-attempt intubation success was 74.6% with rocuronium vs. 79.4% with succinylcholine.
- Rocuronium failed to demonstrate noninferiority to succinylcholine (-4.8% difference).
- Adverse events like hypoxemia and hypotension occurred in both groups.
Conclusions:
- Rocuronium was not found to be noninferior to succinylcholine for first-attempt out-of-hospital intubation.
- Succinylcholine demonstrated a higher success rate in this emergency setting.
- Further research may be needed to clarify agent selection in emergencies.
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