title: Succinylcholine Is Associated with Increased Mortality When Used for Rapid Sequence Intubation of Severely Brain Injured Patients in the Emergency Department.
abstract: OBJECTIVE
  To compare succinylcholine and rocuronium regarding mortality in patients with traumatic brain injury (TBI) who are intubated in the emergency department (ED).
  
  
  METHODS
  This was a retrospective cohort study conducted in an academic ED in the United States. Adult patients with TBI who underwent rapid sequence intubation (RSI) in the ED with rocuronium or succinylcholine between October 2010 and October 2014 were included. The main outcome of interest was in-hospital mortality. Subjects were stratified based on severity of injury using head abbreviated injury scores. The high-severity group had a severe or critical head injury (score 4 or higher); the low-severity group had a less than severe head injury (score lower than 4).
  
  
  RESULTS
  The final study cohort included 233 patients who were underwent RSI with succinylcholine (149 patients) or rocuronium (84 patients). In patients who received rocuronium, mortality was 22% (12/54) and 23% (7/30) in the low-severity and high-severity categories, respectively (difference 1%, 95% confidence interval [CI] -18% to 20%). In patients who received succinylcholine, mortality was 14% (14/103) and 44% (20/46) in the low-severity and high-severity categories, respectively (difference 30%, 95% CI 14-46). In the multivariate analysis after adjusting for important confounders, there was no significant association between succinylcholine and mortality in the low-severity category (odds ratio [OR] 0.75, 95% CI 0.29-1.92). However, in patients in the high-severity category, succinylcholine was associated with increased mortality compared with rocuronium (OR 4.10, 95% CI 1.18-14.12).
  
  
  CONCLUSIONS
  In severely brain-injured patients undergoing RSI in the ED, succinylcholine was associated with increased mortality compared with rocuronium.
authors.affiliation: Department of Pharmacy Practice & Science, College of Pharmacy, The University of Arizona, Tucson, Arizona.
authors.forename: Asad E
authors.initials: AE
authors.lastname: Patanwala
authors.affiliation: Department of Pharmacy Practice & Science, College of Pharmacy, The University of Arizona, Tucson, Arizona.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Erstad
authors.affiliation: Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, Arizona.
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Roe
authors.affiliation: Department of Emergency Medicine, College of Medicine, The University of Arizona, Tucson, Arizona.
authors.forename: John C
authors.initials: JC
authors.lastname: Sakles
mesh_terms: D015998:Abbreviated Injury Scale; D000328:Adult; D000732:Androstanols / Q000009:adverse effects / Q000627:therapeutic use; D001930:Brain Injuries / Q000401:mortality* / Q000628:therapy; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009467:Neuromuscular Depolarizing Agents / Q000009:adverse effects* / Q000627:therapeutic use; D012189:Retrospective Studies; D000077123:Rocuronium; D013390:Succinylcholine / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000732:Androstanols; D009467:Neuromuscular Depolarizing Agents; D013390:Succinylcholine; D000077123:Rocuronium
keywords: brain injuries; intubation; neuromuscular blocking agents; succinylcholine