Association Between Neuromuscular Blocking Agents and Outcomes of Emergency Tracheal Intubation: A Secondary Analysis of Randomized Trials Article

Full Text via DOI: 10.1016/j.annemergmed.2024.08.509 Web of Science: 001393041100001

Cited authors

  • Demasi SC, Self WH, Aggarawal NR, April MD, Andrea L, Barnes CR, Brainard J, Blinder V, Dagan A, Driver B, Doerschug KC, Douglas I, Exline M, Fein DG, Gaillard JP, Gandotra S, Gibbs KW, Ginde AA, Halliday SJ, Han JH, Herbert T, High K, Hughes CG, Khan A, Latimer AJ, Maiga AW, Mitchell SH, Muhs AL, Mohamed A, Moskowitz A, Page DB, Palakshappa JA, Prekker ME, Qian ET, Resnick-Ault D, Rice TW, Russel DW, Schauer SG, Seitz KP, Shapiro NI, Smith LM, Sottile P, Stempek S, Trent SA, Vonderhaar DJ, Walker JE, Wang L, Whitson MR, Casey JD, Semler MW

Abstract

  • Study objective: To examine the association between the neuromuscular blocking agent received (succinylcholine versus rocuronium) and the incidences of successful intubation on the fi rst attempt and severe complications during tracheal intubation of critically ill adults in an emergency department (ED) or ICU. Methods: We performed a secondary analysis of data from 2 multicenter randomized trials in critically ill adults undergoing tracheal intubation in an ED or ICU. Using a generalized linear mixed-effects model with prespecified baseline covariates, we examined the association between the neuromuscular blocking agent received (succinylcholine versus rocuronium) and the incidences of successful intubation on the fi rst attempt (primary outcome) and severe complications during tracheal intubation (secondary outcome). Results: Among the 2,440 patients in the trial data sets, 2,339 (95.9%) were included in the current analysis; 475 patients (20.3%) received succinylcholine and 1,864 patients (79.7%) received rocuronium. Successful intubation on the fi rst attempt occurred in 375 patients (78.9%) who received succinylcholine and 1,510 patients (81.0%) who received rocuronium (an adjusted odds ratio of 0.87; 95% CI 0.65 to 1.15). Severe complications occurred in 67 patients (14.1%) who received succinylcholine and 456 patients (24.5%) who received rocuronium (adjusted odds ratio, 0.88; 95% CI 0.62 to 1.26). Conclusion: Among critically ill adults undergoing tracheal intubation, the incidences of successful intubation on the fi rst attempt and severe complications were not significantly different between patients who received succinylcholine and patients who received rocuronium. [Ann Emerg Med. 2025;85:6-13.]

Authors

Publication date

  • 2024

Published in

International Standard Serial Number (ISSN)

  • 0196-0644

Number of pages

  • 8

Start page

  • 6

End page

  • 13

Volume

  • 85

Issue

  • 1