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

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 [Cl] 35% to 51%), trauma in 26% (39/150; 95% Cl 19% to 33%) and respiratory failure in 31% (47/150; 95% Cl 23% to 39%). No patient was in cardiac arrest at the time of succinylcholine use. The intubation success rate was 92% (138/150; 95% Cl 88% to 96%), with success achieved on the first attempt in 82% of patients (123/150; 95% Cl 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.