ArticleThe western journal of emergency medicine2026
Outcomes of Succinylcholine and Rocuronium for Rapid Sequence Intubation in the Emergency Department.
Article in The western journal of emergency medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionSuccinylcholine and rocuronium are neuromuscular blocking agents commonly used as paralytics in the emergency department (ED) during rapid sequence intubation. Prior studies have shown mixed results regarding the preferred agent aside from settings where there are contraindications. This study compares outcomes of death, myocardial infarction, and post-traumatic stress disorder for succinylcholine vs rocuronium when used in rapid sequence intubation using data from a large, multicenter database.
methodsIn this retrospective study, we extracted 105 million patient records from 61 healthcare organizations in the United States from the TriNetX database between 2004-2023. Adults ≥ 18 years of age who underwent intubation on the same day as an ED visit and received succinylcholine or rocuronium with the hypnotic anesthetic etomidate were included. The outcomes evaluated were mortality and myocardial infarction within 60 days after intubation. We excluded patients with prior history of myocardial infarction. We performed propensity matching for demographics and nine pre-existing conditions associated with mortality.
resultsThere were 15,514 patients in the succinylcholine group and 14,675 patients in the rocuronium group for a total of 30,189 adults prior to propensity matching. The final cohort included 26,884 patients evenly divided between groups after propensity matching. Patients given succinylcholine were associated with a significantly lower risk of mortality (30.1% vs 33.4%, risk ratio [RR] 0.901, 95% CI, 0.869-0.933, P < .001, absolute risk reduction of 3.3%) and myocardial infarction (10.5% vs 11.9%, RR 0.888, 95% CI, 0.828-0.953, P = .001, absolute risk reduction of 1.4%) within 60 days after rapid sequence intubation. Trends were similar before propensity matching.
conclusionSuccinylcholine administration was associated with reduced mortality compared to rocuronium. These findings suggest succinylcholine may be a safer paralytic agent for rapid sequence intubation when no contraindications are identified.
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