CURASMUR
Trial question
Is rocuronium noninferior to succinylcholine in patients undergoing out-of-hospital rapid sequence intubation?
Study design
Multi-center
Single blinded
RCT
Population
Characteristics of study participants
40.0% female
60.0% male
N = 1226
1226 patients (490 female, 736 male).
Inclusion criteria: adult patients requiring out-of-hospital tracheal intubation.
Key exclusion criteria: ager < 18 years; pregnancy; contraindications to rocuronium, succinylcholine, or sugammadex; under guardianship; no health insurance.
Interventions
N=610 rocuronium (intravenous bolus injection of 1.2 mg/kg of body weight).
N=616 succinylcholine (intravenous bolus injection of 1 mg/kg of body weight).
Primary outcome
Successful first-attempt intubation
74.6%
79.4%
79.4 %
59.6 %
39.7 %
19.9 %
0.0 %
Rocuronium
Succinylcholine
Difference exceeding
non-inferiority
margin ✗
Difference exceeding non-inferiority margin in successful first-attempt intubation (74.6% vs. 79.4%; ARD -4.8, 97.5% CI -9 to -1).
Secondary outcomes
No significant difference in Intubation Difficulty Scale score (4.2 points vs. 4.1 points; AD 0.1 points, 95% CI -0.2 to 0.4).
Significant increase in intubation failure under direct laryngoscopy (1.8% vs. 0.7%; AD 1.1%, 95% CI 0.3 to 2.3).
No significant difference in death during prehospital care (1% vs. 0.5%; AD 0.5%, 95% CI -0.4 to 1.3).
Safety outcomes
No significant differences in hypoxemia, cardiac arrest, or pulmonary aspiration.
Significant difference in ≥ 1 severe complication (18.9% vs. 24.4%).
Conclusion
In adult patients requiring out-of-hospital tracheal intubation, rocuronium was not noninferior to succinylcholine with respect to successful first-attempt intubation.
Reference
Bertrand Guihard, Charlotte Chollet-Xémard, Philippe Lakhnati et al. Effect of Rocuronium vs Succinylcholine on Endotracheal Intubation Success Rate Among Patients Undergoing Out-of-Hospital Rapid Sequence Intubation: A Randomized Clinical Trial. JAMA. 2019 Dec 17;322(23):2303-2312.
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