Roc Vs. Sux, Settled

Short answer: rocuronium, just because.

Better answer: it really doesn’t matter, please stop devoting neurons and pages to the debate.

This is a result from the National Emergency Airway Registry, a prospective database of ED airway procedures. In the sample analyzed, there were 4,275 intubations, roughly split evenly between succinylcholine and rocuronium. Generally, the cohorts were well-matched on baseline and operator characteristics.

The winner, and still champion is: they tied. First-pass success, a surrogate for effectiveness as a paralytic, was effectively identical between agents at ~87%. Adverse events, patient-oriented outcomes relating to procedural harms, were likewise effectively identical at ~15%.

This is not a randomized controlled trial, so it’s not possible to fully exclude a selection bias in which patient-level characteristics influenced the choice of agent. However, these are consistent with a Bayesian pretest likelihood of clinical equivalency. Frankly, I don’t think the cost of an RCT adds much value over these observational data sets, and any dogmatic attachment to one agent over another should be expunged. Certain clinical situations may make one agent more preferable than another, but, generally speaking, they are both excellent and effective tools.

“Emergency Department Intubation Success With Succinylcholine Versus Rocuronium: A National Emergency Airway Registry Study”
https://www.annemergmed.com/article/S0196-0644(18)30318-4/fulltext