Out-of-hospital succinylcholine-assisted endotracheal intubation by paramedics.
OBJECTIVE
To describe the effectiveness and safety of succinylcholine administration by paramedics to out-of-hospital patients requiring endotracheal intubation.


METHODS
A consecutive case series was collected by retrospective review of patient care records from a large, private ambulance agency serving an urban and rural county of 600,000 residents over a 40-month period. All patients for whom endotracheal intubation was facilitated by succinylcholine use were identified. Data were systematically collected on demographics, paramedic diagnosis, intubation attempts, and complications.


RESULTS
Succinylcholine was used in 150 patients with a mean age (+/-SD) of 50+/-23 years. Paramedic diagnosis was coma in 43% (64/150; 95% confidence interval [CI] 35% to 51%), trauma in 26% (39/150; 95% CI 19% to 33%), and respiratory failure in 31% (47/150; 95% CI 23% to 39%). No patient was in cardiac arrest at the time of succinylcholine use. The intubation success rate was 92% (138/150; 95% CI 88% to 96%), with success achieved on the first attempt in 82% of patients (123/150; 95% CI 76% to 88%). Four patients who received succinylcholine developed cardiac arrest, and 3 others had symptomatic bradycardia.


CONCLUSIONS
The use of succinylcholine by paramedics to assist intubation appears to aid in intubation of patients who are not in cardiac arrest. However, significant cardiac complications can occur.
Pace
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SA
Madigan Army Medical Center, Department of Emergency Medicine, Fort Lewis, WA 98431, USA. stpace@u.washington.edu
Fuller
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FP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000488:Allied Health Personnel; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest / Q000139:chemically induced; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D009467:Neuromuscular Depolarizing Agents / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies; D013390:Succinylcholine / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
D009467:Neuromuscular Depolarizing Agents; D013390:Succinylcholine