Department of Emergency Medicine BH, Wake Forest University, Winston-Salem, North Carolina 27157, USA.
Prehosp Emerg Care. 2011 Oct-Dec;15(4):457-63. doi: 10.3109/10903127.2011.569853. Epub 2011 May 13.
It is not known how rocuronium compares with succinylcholine in its effect on intubation success during air medical rapid-sequence intubation (RSI).
To examine the impact of succinylcholine use on the odds of successful prehospital intubation.
We performed a retrospective analysis of a critical care transport service administrative database containing patient encounters from 2004 to 2008. Rotor transports of patients ≥ 18 years old, requiring airway management (intubation or backup airway: laryngeal mask airway, Combitube, or cricothyrotomy), and receiving either rocuronium or succinylcholine were included in the analysis. Patients receiving both drugs were excluded. Multiple imputation was used to account for records that were missing data elements. A propensity score based on patient and encounter characteristics was calculated to control for the effect of clinical factors on the choice of drug by air medical personnel. Logistic regression was used to assess the impact of succinylcholine use on the odds of first-attempt intubation. Ordinal logistic regression was used to assess the impact of succinylcholine on the number of attempts required to intubate (1, 2, or ≥ 3 or backup airway).
A total of 1,045 patients met the criteria for analysis; 761 (73%) were male, and the median age was 41 years (interquartile range 26-56). Eight hundred seventy-six (84%) were transported from the scene, and 484 (46%) received succinylcholine. Six hundred twelve (59%) were intubated on the first attempt, 322 (31%) required two attempts, 69 required three or more attempts (7%), and 42 required a backup airway (4%). After propensity score adjustment, succinylcholine was associated with a higher incidence of first-attempt intubation (odds ratio 1.4, 95% CI 1.1-1.8), as well as improved odds for requiring fewer attempts to intubate (odds ratio 1.5, 95% CI 1.2-1.9), as compared with rocuronium.
Rapid-sequence intubation was more successful with fewer attempts in patients intubated by air medical crews with succinylcholine as opposed to rocuronium. Prospective, randomized studies are needed to confirm these findings and to explore the impact of succinylcholine on the outcomes of air medical-transported patients. Key words: airway management; critical care; emergency medical services; neuromuscular blockade; succinylcholine; rocuronium; rapid-sequence intubation; intubation; air medical transport.
在航空医疗快速序贯插管（RSI）中，罗库溴铵与琥珀酰胆碱在插管成功率方面的效果如何尚不清楚。
研究琥珀酰胆碱的使用对院前插管成功率的影响。
我们对包含 2004 年至 2008 年患者就诊信息的重症监护转运服务管理数据库进行了回顾性分析。纳入年龄≥18 岁、需要气道管理（插管或备用气道：喉罩、Combitube 或环甲膜切开术）并接受罗库溴铵或琥珀酰胆碱治疗的转运行患者。排除同时接受两种药物的患者。采用多重插补法处理记录中缺失数据元素的情况。根据患者和就诊特征计算倾向评分，以控制航空医疗人员选择药物的临床因素的影响。采用 logistic 回归评估琥珀酰胆碱使用对首次插管尝试的几率的影响。采用有序 logistic 回归评估琥珀酰胆碱对插管所需尝试次数（1、2 或≥3 次或备用气道）的影响。
共有 1045 例患者符合分析标准；761 例（73%）为男性，中位年龄为 41 岁（四分位距 26-56）。876 例（84%）从现场转运，484 例（46%）接受琥珀酰胆碱治疗。612 例（59%）患者首次尝试插管成功，322 例（31%）需要 2 次尝试，69 例需要 3 次或更多次尝试（7%），42 例需要备用气道（4%）。经倾向评分调整后，与罗库溴铵相比，琥珀酰胆碱与首次插管尝试的更高几率相关（比值比 1.4，95%置信区间 1.1-1.8），且需要较少尝试插管的几率也更高（比值比 1.5，95%置信区间 1.2-1.9）。
与罗库溴铵相比，航空医疗人员使用琥珀酰胆碱进行快速序贯插管时，成功率更高，尝试次数更少。需要进行前瞻性、随机研究来证实这些发现，并探讨琥珀酰胆碱对航空医疗转运患者结局的影响。关键词：气道管理；危重病医学；急救医疗服务；神经肌肉阻滞；琥珀酰胆碱；罗库溴铵；快速序贯插管；插管；航空医疗转运。
