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
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
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 |
| Chronic renal failure | 28 |
| Rhabdomyolysis | 6 |
| Lack of medical history | 43 |
| Known hyperkalemia | 11 |
| Neuromuscular disease | 11 |
Criticisms & Further Discussion
- Onset of paralysis was only directly measured in 30-40% patients, with the rest being estimated by intubator
- While estimated times were very similar to measured times, this introduces a potential for recall bias and inaccuracy of onset timing
- 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.