Pre-Hospital Interventions: RSI

Which is the best muscle relaxant for RSI in the field? 🚑

Let’s dive into a recent study comparing Succinylcholine and Rocuronium for RSI in prehospital care, including their mechanisms of action and implications for EMS professionals.

🚨 Study Key Points:

⁍Analyzed 5179 EMS cases from Seattle Fire over a 7-year period (2015 to 2022).

✓ Succinylcholine group: 329 patients

✓ Rocuronium group: 1,146 patients

⁍ Excluded: Cardiac arrest cases, no prior blockade, under 18, both drugs used, video laryngoscopy, missing capnography

Results Summary:

➊ Laryngoscopy views: No difference.

➋ Time to:

a. First attempt: Sux (57s) vs. Roc (83s).

b. Successful intubation: Sux (132s) vs. Roc (162s).

➌ Bougie use: Sux (62%) vs. Roc (94%).

➍ First pass success: Similar (Sux 84%, Roc 83%).

➎ Hypoxemia: Comparable (Sux 25%, Roc 23%).

🔍 Conclusion of this paper:

➡ Prehospital use of either rocuronium or succinylcholine is associated with similar:

1. Similar Cormack-Lehane grades

2. First-pass success rates

3. Rates of peri-intubation hypoxemia

Analysis :

☑Well-executed study on a crucial topic.

☑ Excluded video laryngoscopy (VL) cases.

☑ The 23-25% hypoxemia rates highlight Dr. Jarvis's 2018 publication on (delayed sequence, intubation) DSI.

- He demonstrated a reduction in hypoxia from 44% down to 3.5% using DSI.

- Link: https://pubmed.ncbi.nlm.nih.gov/29530653/.

☑ It is recommended that more agencies to adopt DSI, showing significant benefits over RSI.

➼ What’s your experience? Do you prefer one over the other? 🗣️👩‍🚒👨‍🚒

📚 Full study details here: https://www.handtevy.com/wp-content/uploads/2023/12/Comparison-of-intubating-conditions-with-succinylcholine-versus-rocuronium-in-the-prehospital-setting.pdf