![]() 2, 3 Rapid sequence intubation (RSI) is therefore the most widely recommended sedation technique for patients requiring emergency tracheal intubation. 1 Several clinical studies have reported that sedation greatly improves ease and safety of this emergency procedure. Tracheal intubation is one of the most critical interventions in emergency settings. Trial Registration Identifier: NCT02000674 The most common intubation-related adverse events were hypoxemia (55 of 610 patients ) and hypotension (39 of 610 patients ) in the rocuronium group and hypoxemia (61 of 616 ) and hypotension (62 of 616 patients ) in the succinylcholine group.Ĭonclusions and Relevance Among patients undergoing endotracheal intubation in an out-of-hospital emergency setting, rocuronium, compared with succinylcholine, failed to demonstrate noninferiority with regard to first-attempt intubation success rate. The number of patients with successful first-attempt intubation was 455 of 610 (74.6%) in the rocuronium group vs 489 of 616 (79.4%) in the succinylcholine group, with a between-group difference of −4.8% (1-sided 97.5% CI, −9% to ∞), which did not meet criteria for noninferiority. Results Among 1248 patients who were randomized (mean age, 56 years 501 women), 1230 (98.6%) completed the trial and 1226 (98.2%) were included in the per-protocol analysis. A per-protocol analysis was prespecified as the primary analysis. A noninferiority margin of 7% was chosen. Main Outcomes and Measures The primary outcome was the intubation success rate on first attempt. ![]() Interventions Patients were randomly assigned to undergo tracheal intubation facilitated by rocuronium (n = 624) or succinylcholine (n = 624). The date of final follow-up was August 31, 2016. Enrollment occurred from January 2014 to August 2016 in 17 French out-of-hospital emergency medical units. Objective To assess the noninferiority of rocuronium vs succinylcholine for tracheal intubation in out-of-hospital emergency situations.ĭesign, Setting and Participants Multicenter, single-blind, noninferiority randomized clinical trial comparing rocuronium (1.2 mg/kg) with succinylcholine (1 mg/kg) for rapid sequence intubation in 1248 adult patients needing out-of-hospital tracheal intubation. Succinylcholine use has been associated with several adverse events not reported with rocuronium. Importance Rocuronium and succinylcholine are often used for rapid sequence intubation, although the comparative efficacy of these paralytic agents for achieving successful intubation in an emergency setting has not been evaluated in clinical trials. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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