Out-of-hospital succinylcholine-assisted endotracheal intubation by paramedics

• Published in: Annals of emergency medicine Vol. 35; no. 6; pp. 568 - 572
• Main Authors: Pace, Steven A., Fuller, Frederick P.
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.06.2000
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Allied Health Personnel; Child; Child, Preschool; Emergency Medical Services; Female; Heart Arrest - chemically induced; Humans; Intubation, Intratracheal; Male; Middle Aged; Neuromuscular Depolarizing Agents - administration & dosage; Neuromuscular Depolarizing Agents - adverse effects; Retrospective Studies; Succinylcholine - administration & dosage; Succinylcholine - adverse effects; Treatment Outcome
• ISSN: 0196-0644; 1097-6760
• DOI: 10.1016/S0196-0644(00)70029-1

Study 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. Conclusion: 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 SA, Fuller FP. Out-of-hospital succinylcholine-assisted endotracheal intubation by paramedics. Ann Emerg Med . June 2000;35:568-572.]