Helen Wang, PharmD
Senior Pharmacist
Brigham & Women's Hospital
Boston, Massachusetts
Disclosure information not submitted.
Kaitlin Crowley, BCCCP, BCPS, PharmD (she/her/hers)
Clinical Pharmacy Specialist
Brigham & Women's Hospital
Disclosure information not submitted.
Lena Tran, PharmD, BCCCP
Senior Pharmacist
Brigham & Women's Hospital, Massachusetts, United States
Disclosure information not submitted.
Sarah Culbreth, PharmD, BCPS
Pharmacy Manager
Brigham and Women's Hospital, United States
Disclosure information not submitted.
Kaylee Marino, PharmD, BCPS, BCCCP
Clinical Pharmacy Specialist
Brigham and Womens Hospital, United States
Disclosure information not submitted.
Title: Rocuronium Versus Succinylcholine for Rapid Sequence Intubation in the Emergency Department
Introduction: Succinylcholine and rocuronium are commonly used paralytics for rapid sequence intubation (RSI). Prior studies have found reduced first attempt intubation success (FAIS) with rocuronium compared to succinylcholine. Recent studies using higher rocuronium doses have indicated no difference in FAIS. The objective of this study was to compare FAIS rates for rocuronium and succinylcholine when used for RSI in the emergency department (ED).
Methods: This was a single-center, retrospective, IRB-approved study. Patients were included if they received either succinylcholine or rocuronium for RSI in the ED from January 2016 to August 2020. The primary endpoint was FAIS. Secondary endpoints included change in vital signs or potassium, vasopressor use post-intubation, and development of hyperkalemia or complications from intubation. Subgroup analyses were performed evaluating the impact of weight-based dosing on FAIS for each agent. Rocuronium weight-based dose groups were divided into < 1.0 mg/kg, 1.0-1.1 mg/kg, 1.2-1.3 mg/kg, and ≥1.4 mg/kg. Succinylcholine weight-based dose groups were divided into < 1.5 mg/kg, 1.5-1.9 mg/kg, and ≥2.0 mg/kg.
Results: There were 448 patients in the rocuronium group and 183 patients in the succinylcholine group. There were no differences in baseline characteristics between the groups. No difference was observed in FAIS between patients receiving rocuronium (median dose: 1.22 mg/kg, IQR 1.04-1.55) or succinylcholine (median dose: 1.43 mg/kg, IQR 1.25-1.67) (361 (80.6%) vs. 150 (82.0%), p=0.69). There was no difference in change in potassium after paralytic administration (-0.2 mEq/L, IQR 0.6-0.3 vs. -0.1 mEq/L, IQR -0.4-0.4, p=0.10) between the rocuronium and succinylcholine groups. There were no differences in other secondary endpoints or in FAIS between the weight-based dose groups for each agent.
Conclusions: These findings were consistent with those from recent studies indicating no difference in FAIS between rocuronium and succinylcholine when higher doses of rocuronium were used. There was no difference between groups in change in potassium after paralytic administration. This study evaluated weight-based dose groups for each paralytic and found no differences. Larger prospective studies are warranted to further evaluate the effect of weight-based paralytic dosing on FAIS.