Comparing Succinylcholine with Rocuronium for First-Pass Success During Rapid Sequence Intubation at an Academic Emergency Department

Introduction: Succinylcholine and Rocuronium are the principal neuromuscular blocking (NMB) agents used for rapid sequence intubation (RSI). Previous studies comparing the two agents show controversial results. A Cochrane systematic review revealed that Succinylcholine was more likely to achieve good intubating conditions than Rocuronium. This study aimed to compare Succinylcholine (1.5 mg/kg) versus Rocuronium (1.2 mg/kg) and their association with first-pass success during RSI. Methods: This was a retrospective study at a single academic emergency department. We included patients who underwent RSI with either Succinylcholine or Rocuronium between 2017 to 2021. The primary outcome was first-pass success, whereas the secondary outcome was clinically acceptable intubation conditions. Logistic regression analysis was used to compare both agents. Results: This sample included a total of 342 patients. Of whom, 201 (58.7%) patients received Succinylcholine and 141 (41.2%) received Rocuronium. Unadjusted comparison between Succinylcholine and Rocuronium revealed no difference in first-pass success rates (84.3% vs. 82.9%; p= 0.23) and had similar clinically acceptable intubation conditions (89.9% vs. 88.3%; p= 0.19). After adjusting for confounding factors, first-pass success rates (p= 0.22) and clinically acceptable intubation conditions (p= 0.19) remained similar between the two agents. Conclusion: The use of 1.5 mg/kg of Succinylcholine compared with 1.2 mg/kg of Rocuronium revealed statistically similar first pass success rates and clinically acceptable intubation conditions.