• Asad E Patanwala, Sara A Stahle, John C Sakles, and Brian L Erstad.
• Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA. patanwala@pharmacy.arizona.edu
• Acad Emerg Med. 2011 Jan 1;18(1):10-4.

ObjectivesThe objective was to determine the effect of paralytic type and dose on first-attempt rapid sequence intubation (RSI) success in the emergency department (ED).MethodsThis was a retrospective evaluation of information collected prospectively in a quality improvement database between July 1, 2007, and October 31, 2008. Information regarding all intubations performed in a tertiary care ED was recorded in this database. All RSI performed using succinylcholine or rocuronium were included. Logistic regression was used to analyze the effect of paralytic type and dosing, as well as age, sex, body mass index, physician experience, device type, and presence of difficult airway predictors on first attempt RSI success.ResultsA 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. In the univariate logistic regression analyses, variables predictive of first-attempt intubation success were laryngeal view (more success if Grade 1 or 2 compared to Grade 3 or 4 of the Cormack-Lehane classification, odds ratio [OR] =55.18, 95% confidence interval [CI]=18.87 to 161.39), intubation device (less success if direct laryngoscopy, OR=0.57, 95% CI=0.34 to 0.96), and presence of a difficult airway predictor (OR=0.55, 95% CI=0.31 to 0.99). In the multivariate analysis, the only variable predictive of first-attempt intubation success was laryngeal view.ConclusionsSuccinylcholine and rocuronium are equivalent with regard to first-attempt intubation success in the ED when dosed according to the ranges used in this study.© 2010 by the Society for Academic Emergency Medicine.

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