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Rocuronium and succinylcholine are the most commonly used paralytics in rapid sequence intubation (RSI) in U.S. emergency departments (EDs). Some clinicians advocate for one medication over the other as they have distinct properties: Succinylcholine has a faster onset and wears off more quickly; rocuronium has fewer contraindications. However, data have largely come from registry studies or operating room experience.
In this multicenter noninferiority trial, 1248 adult patients undergoing prehospital RSI in France were randomized to receive either succinylcholine (1.0 mg/kg) or rocuronium (1.2 mg/kg). Patients were intubated using direct laryngoscopy and clinicians used stylets in fewer than 10% of intubations. First-pass success occurred in…