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• W2979662777 abstract "The recommended rocuronium dose for rapid sequence intubation (RSI) is 1.0 mg/kg but the optimal dose for emergency airway management is not clear. We assessed the relationship between escalating rocuronium dosing with first-attempt success and peri-intubation adverse events in emergency department patients. We analyzed data from an observational 25-center registry of ED intubations. All patients > 14 years of age who received rocuronium for RSI from Jan 1 2016 to Dec 31, 2018 were included. We performed logistic regressions controlling for predictors of airway difficulty, indication, pre-intubation hemodynamics, operator, body habitus and device to assess whether rocuronium dosing <1.4mg/kg versus ≥1.4mg/kg was a predictor of first-attempt success or adverse events. Additionally, we differentiated between <1.0 mg/kg, 1.0-1.1 mg/kg, 1.2-1.3 mg/kg and ≥1.4mg/kg. Subgroup analyses stratified by device (direct vs. video laryngoscopy) was also performed. We report univariate descriptive statistics and odds ratios (OR) from multivariable logistic regressions with cluster-adjusted 95% confidence intervals (CI). Investigators recorded data on 19,071 encounters. Of these, 8,226 were performed using rocuronium with doses of <1.0 mg/kg, 1.0-1.1 mg/kg, 1.2-1.3 mg/kg and ≥1.4mg/kg in 1,309, 2,559, 1,919, and 2,439 encounters, respectively. 45.7% utilized direct laryngoscopy while 53.3% used video laryngoscopy. Overall, first attempt success was greater in the ≥1.4mg/kg versus the <1.4mg/kg group OR 0.7 (95% CI 0.6-0.9). First-attempt success across dosing ranges was 88.5% for the < 1.0 mg/kg, 88.1% for 1.0-1.1 mg/kg, 89.7% for 1.2-1.3mg/kg and 92.0% for the ≥1.4mg/kg. After logistic regression controlling for confounders, odds of a first-attempt success was significantly lower in the smaller dosing ranges compared with the ≥1.4mg/kg cohort when direct laryngoscopy was used: OR 0.4 (95% CI 0.3-0.7) for < 1.0 mg/kg, OR 0.5 (95% CI 0.3-0.8) for 1.0-1.1 mg/kg, and OR 0.6 (95% CI 0.5-0.8) for the 1.2-1.3 mg/kg group, see Figure 1. First-attempt success was similar when video laryngoscopy was used. The rates of all peri-intubation adverse events and desaturation were similar between groups. In this large observational series, rocuronium dosed ≥1.4mg/kg resulted in higher first attempt success overall compared to <1.4mg/kg with no increase in adverse events. When direct laryngoscopy was used, this difference was more profound. Emergency physicians should consider administering higher doses of rocuronium when intubating with a conventional laryngoscope." @default.
• W2979662777 created "2019-10-18" @default.
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• W2979662777 date "2019-10-01" @default.
• W2979662777 modified "2023-09-26" @default.
• W2979662777 title "38 The Impact of Rocuronium Dose on First-Attempt Intubation Success" @default.
• W2979662777 doi "https://doi.org/10.1016/j.annemergmed.2019.08.041" @default.
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