• Stephanie C DeMasi, Wesley H Self, Neil R Aggarawal, Michael D April, Luke Andrea, Christopher R Barnes, Jason Brainard, Veronika Blinder, Alon Dagan, Brian Driver, Kevin C Doerschug, Ivor Douglas, Matthew Exline, Daniel G Fein, John P Gaillard, Sheetal Gandotra, Kevin W Gibbs, Adit A Ginde, Stephen J Halliday, Jin H Han, Taylor Herbert, Kevin High, Christopher G Hughes, Akram Khan, Andrew J Latimer, Amelia W Maiga, Steven H Mitchell, Amelia L Muhs, Amira Mohamed, Ari Moskowitz, David B Page, Jessica A Palakshappa, Matthew E Prekker, Edward T Qian, Dan Resnick-Ault, Todd W Rice, Derek W Russel, Steven G Schauer, Kevin P Seitz, Nathan I Shapiro, Lane M Smith, Peter Sottile, Susan Stempek, Stacy A Trent, Derek J Vonderhaar, James E Walker, Li Wang, Micah R Whitson, Jonathan D Casey, Matthew W Semler, and Pragmatic Critical Care Research Group.
• Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN. Electronic address: stephanie.demasi@vumc.org.
• Ann Emerg Med. 2025 Jan 1; 85 (1): 6136-13.

Study ObjectiveTo examine the association between the neuromuscular blocking agent received (succinylcholine versus rocuronium) and the incidences of successful intubation on the first attempt and severe complications during tracheal intubation of critically ill adults in an emergency department (ED) or ICU.MethodsWe 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 first attempt (primary outcome) and severe complications during tracheal intubation (secondary outcome).ResultsAmong 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 first 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).ConclusionAmong critically ill adults undergoing tracheal intubation, the incidences of successful intubation on the first attempt and severe complications were not significantly different between patients who received succinylcholine and patients who received rocuronium.Copyright © 2024 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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