EBQ:Comparison of Succinylcholine and Rocuronium for RSI

Under Review Journal Club Article

Laurin EG, et al. "A Comparison of Succinylcholine and Rocuronium for Rapid-sequence Intubation of Emergency Department Patients". Academic Emergency Medicine. 2000. 7(12):1362-9.
PubMed PDF

Clinical Question

How do succinylcholine and rocuronium compare for use is rapid-sequence intubation in the emergency department?

Conclusion

Both succinylcholine and rocuronium produce fast and reliable paralysis for RSI in the ED.

Major Points

Result	Succinylcholine	Rocuronium
Time of Onset (± SD)	39 (± 13) seconds	44 (± 20) seconds
Mean Dosage	1.7 mg/kg	1.0 mg/kg
Satisfaction 0-10 (± SD)	9.4 (± 1.3)	8.8 (± 2.0)

Study Design

• Data form completed by intubator immediately after intubation with following info
  • Patient's name, age, gender, paralytic used, reason for use, time from administration to paralysis, serum K at time of intubation, need for BVM ventilations, pulse ox readings during intubation, any complications

Population

Patient Demographics

• Mean age: 46 years old
  • Range: days old-96 years old
• Male: 63%

Inclusion Criteria

• Every patient intubated in the ED from January 1, 1998 to December 31, 1998 was eligible for enrollment

Interventions

Prospective observational study of paralytic use in ED

Outcomes

N= 521 patients who received RSI in the ED

• 382 (73%) received succinylcholine
• 138 (26%) received rocuronium

Indications for

Common Indications for Rocuronium Use	Number of Patients
Suspected hyperkalemia	53
Chronic renal failure	28
Rhabdomyolysis	6
Lack of medical history	43
Known hyperkalemia	11
Neuromuscular disease	11