Succinylcholine Versus Rocuronium for Emergency Intubation in Intensive Care

Phase 4

Completed

Brief Summary: Emergency intubation of patients in intensive care is a high-risk endeavour. For many decades, succinylcholine has been the neuromuscular blocking agent of choice. However, succinylcholine may have life-threatening side effects and is contraindicated in a variety of diseases relevant in intensive care. The nondepolarizing agent rocuronium has been propagated as alternative for succinylcholine. Though a recent meta-analysis found no difference in intubating conditions between succinylcholine and rocuronium in elective cases, there are no data in emergent cases in intensive care. The aim of the present study is to compare succinylcholine and rocuronium with regard to 1) quality of intubating conditions, 2) length of the intubating sequence, 3) failed intubating attempts, 4) hemodynamic sequelae of intubation, and 5) desaturations.

Detailed Description: Objective: to compare succinylcholine and rocuronium with regard to 1) quality of intubating conditions, 2) length of the intubating sequence, 3) failed intubating attempts, 4) hemodynamic sequelae of intubation, and 5) desaturations.

Design: prospective, randomized, single-blind study. Setting: Intensive care units of an University Hospital. Patients: adult patients in intensive care requiring emergency intubation. Randomization: 1:1 randomization to either succinylcholine (1mg/kg) or rocuronium (0.6 mg/kg).

Data: 1) assessment of the quality of intubating conditions by means of a score, 2) length of the intubating sequence defined as time between injection of neuromuscular blocking agent and first end-tidal CO2 on the monitor, 3) number of failed intubating attempts, 4) hemodynamic sequelae of intubation, defined as events requiring injection of vasoactive drugs, and 5) desaturations, defined as saturation below 90% and/or any decrease in saturation of 5% or more.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Arm && Interventions

Group	Intervention	Description
Succinylcholine	Succinylcholine	-
Rocuronium	Rocuronium	-

Primary Outcome Measures

Name	Time	Method
Number of Participants Exhibiting Desaturation >5%	at any time between the start of the intubation sequence and 2min after the completion of intubation	decrease of \>5% in oxygen saturation measured continuously using pulse oxymetry

Secondary Outcome Measures

Name	Time	Method
Haemodynamic Sequelae of Intubation	between start of induction sequence and 5 min after completion of intubation	any new haemodynamic alteration requiring immediate intervention
Time to Completion of Intubation	time interval between the injection of the induction agent and the first appearance of endtidal CO2	time interval between the injection of the induction agent and the first appearance of endtidal CO2
Quality of Intubation Conditions Using a Validated Score: Viby-Mogensen et al. Good Clinical Research Practice (GCRP) in Pharmacodynamic Studies of Neuromuscular Blocking Agents. Acta Anaesthesiol Scand 1996;40:59-74.	during laryngoscopy and the first minute after completion of intubation	The factors laryngoscopy, vocal cords, and response to intubation are individually rated with a score from 1 (bad intubation conditions)to 3 (excellent intubation conditions)and the resulting three scores are summed up. The maximum score is thus 9 while the minimum score is 3. Units: measure on a scale
Number of Participants With an Failed First Intubation Attempts	within the first 90 sec following the start of induction	defined as either uncompleted intubation attempt within 90 sec or starting a second intubation attempt