Sux vs Roc in ED RSI

January 18, 2011 by  
Filed under All Updates, ICU, Resus

Suxamethonium and rocuronium were compared in a database of prospectively recorded cases of RSI in the emergency department.

A total of 327 RSI were included in the final analyses. All patients received etomidate as the induction sedative and were successfully intubated. Of these, 113 and 214 intubations were performed using succinylcholine and rocuronium, respectively.

  • The rate of first-attempt intubation success was similar between the succinylcholine and rocuronium groups (72.6% vs. 72.9%, p = 0.95).
  • Median doses used for succinylcholine and rocuronium were 1.65 mg/kg (interquartile range [IQR] = 1.26–1.95 mg/kg) and 1.19 mg/kg (IQR = 1–1.45 mg/kg), respectively.
  • The median dose of etomidate was 0.25 mg/kg in both groups.

In this study succinylcholine and rocuronium were equivalent with regard to first-attempt intubation success in the ED. This finding is consistent with previous investigations that used doses between 0.9 and 1.2 mg/kg and found similar intubating conditions to succinylcholine at these higher doses; subgroup analyses of studies using a lower rocuronium dose of 0.6 to 0.7 mg/kg had a relative risk favoring succinylcholine for excellent intubating conditions.

The low (in my view) rate of first-attempt intubation success in both groups was (72.6% vs. 72.9%), does make one wonder whether the intubating clinicians optimised their strategy for first-pass success.

Comparison of Succinylcholine and Rocuronium for First-attempt Intubation Success in the Emergency Department
Acad Emerg Med. 2011;18:11-14


One Response to “Sux vs Roc in ED RSI”

  1. The LITFL Review 003 - Life in the FastLane Medical Blog on January 23rd, 2011 23:57

    [...] Cliff’s post on Open Thoracoscopy for resuscitation the docs, IS A MUST READ POST! Nothing else need be said. Cliff also takes on the always bloody debate surrounding Sux vs Roc in ED RSI. [...]