EBQ:Comparison of Succinylcholine and Rocuronium for RSI: Difference between revisions

(outcomes)
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! Result !! Succinylcholine !! Rocuronium
! Result !! Succinylcholine !! Rocuronium
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| Time of Onset (± SD) || 39 (± 13) seconds || 44 (± 20) seconds
| Measured time of Onset (± SD) || 39 (± 13) seconds || 44 (± 20) seconds
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| Mean Dosage || 1.7 mg/kg || 1.0 mg/kg
| Mean Dosage || 1.7 mg/kg || 1.0 mg/kg
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==Criticisms & Further Discussion==
==Criticisms & Further Discussion==
*Onset of paralysis was only directly measured in 30-40% patients, with the rest being estimated by the person intubating
*Onset of paralysis was only directly measured in 33% patients, with the rest being estimated by the person intubating
**While estimated times were very similar to measured times (within 4 seconds), this introduces a potential for recall bias and inaccuracy of onset timing
**Significant difference (p=0.04) was calculated only for the measured values, but no statistical significance was calculated for estimated values
*As no specific inclusion or exclusion criteria were given, physicians could hand-pick patients to include in the study, introducing the possibility for selection bias.
**Although statistical significance of onset time was established, clinical significance is unclear as there were no incidences of desaturation in either group
*Physicians were allowed to hand-pick patients to include in the study without specific inclusion/exclusion criteria, introducing the possibility for selection bias.
*Patients were not randomized, and physicians were not blinded to medication choice.  
*Patients were not randomized, and physicians were not blinded to medication choice.  
**The subjective satisfaction score may be biased
**Satisfaction score, estimated time to paralysis may be biased
*Other new non-depolarizing agents, in addition to rocuronium, should be considered in future studies for use in the ED


==External Links==
==External Links==

Revision as of 15:22, 17 September 2015

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
Measured 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

Exclusion Criteria

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 (38%)
    Chronic renal failure 28
    Rhabdomyolysis 6
Lack of medical history 43 (31%)
Known hyperkalemia 11 (8%)
Neuromuscular disease 11 (8%)


Common sedative agents used:

  • Etomidate: 464 patients (89%), mean dose 0.29 mg/kg
  • Midaolam: 12 patients(2%), mean dose 0.09 mg/kg
  • Obtunded--no sedative used: 15 patients (3%)
  • No sedation recorded: 14 patients (2%)

Criticisms & Further Discussion

  • Onset of paralysis was only directly measured in 33% patients, with the rest being estimated by the person intubating
    • Significant difference (p=0.04) was calculated only for the measured values, but no statistical significance was calculated for estimated values
    • Although statistical significance of onset time was established, clinical significance is unclear as there were no incidences of desaturation in either group
  • Physicians were allowed to hand-pick patients to include in the study without specific inclusion/exclusion criteria, introducing the possibility for selection bias.
  • Patients were not randomized, and physicians were not blinded to medication choice.
    • Satisfaction score, estimated time to paralysis may be biased

External Links

Funding

References

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