Methods
Data Sources
The authors searched the Cochrane Central Register of Controlled Trials (2015, Issue 2), MEDLINE (1966 to February week 2, 2015), and EMBASE (1988 to February 14, 2015) without language restrictions. For additional citations, the authors searched references of selected articles.
Study Selection
All randomized controlled trials and controlled clinical trials were reviewed that compared the use of rocuronium (≥0.6 mg/kg) and succinylcholine (≥1 mg/kg) for rapid sequence intubation and reported intubating conditions. Patients of any age were included in any clinical setting.
Data Extraction and Synthesis
Two authors independently screened studies for inclusion, extracted data, and assessed methodological quality, using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Study bias was assessed with the risk-of-bias tool. Patient analysis followed the intention-to-treat principle. Treatment effects were reported with a random-effects model and heterogeneity was assessed with the I 2 statistic.
Methods
Data Sources
The authors searched the Cochrane Central Register of Controlled Trials (2015, Issue 2), MEDLINE (1966 to February week 2, 2015), and EMBASE (1988 to February 14, 2015) without language restrictions. For additional citations, the authors searched references of selected articles.
Study Selection
All randomized controlled trials and controlled clinical trials were reviewed that compared the use of rocuronium (≥0.6 mg/kg) and succinylcholine (≥1 mg/kg) for rapid sequence intubation and reported intubating conditions. Patients of any age were included in any clinical setting.
Data Extraction and Synthesis
Two authors independently screened studies for inclusion, extracted data, and assessed methodological quality, using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Study bias was assessed with the risk-of-bias tool. Patient analysis followed the intention-to-treat principle. Treatment effects were reported with a random-effects model and heterogeneity was assessed with the I 2 statistic.
Results
Of the 66 identified studies, 50 met inclusion criteria for analysis, comprising 4,151 patients. Main outcomes and selected subgroup analysis are summarized in the Table . The overall evidence was deemed moderate quality because of a high incidence of detection bias (ie, 50% of the intubators were not blinded to the fasciculations caused by succinylcholine), and there was substantial heterogeneity among the trials, which could not be explained by subgroup analysis. Although subgroup analysis of emergency intubations determined that succinylcholine is superior to rocuronium in achieving excellent intubating conditions, there was no difference between the 2 drugs in terms of clinically acceptable intubating conditions. In the pediatric subgroup analysis, there was no difference between rocuronium and succinylcholine; however, the sample size was small and substantial heterogeneity was identified. None of the trials in this systematic review reported severe adverse outcomes.
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