Pub Date : 2024-10-18DOI: 10.1016/j.annemergmed.2024.06.006
José Nunes de Alencar MD
{"title":"When ECG Leads Lead Us Astray","authors":"José Nunes de Alencar MD","doi":"10.1016/j.annemergmed.2024.06.006","DOIUrl":"10.1016/j.annemergmed.2024.06.006","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"84 5","pages":"Pages 579-582"},"PeriodicalIF":5.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-18DOI: 10.1016/j.annemergmed.2024.09.009
Crystal Phend (Special Contributor to Annals News & Perspective)
{"title":"As Mental and Behavioral Health Crises Tax Emergency Departments, New Strategies Are Emerging","authors":"Crystal Phend (Special Contributor to Annals News & Perspective)","doi":"10.1016/j.annemergmed.2024.09.009","DOIUrl":"10.1016/j.annemergmed.2024.09.009","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"84 5","pages":"Pages A11-A13"},"PeriodicalIF":5.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142530187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-18DOI: 10.1016/j.annemergmed.2024.06.002
Jesse M. Pines MD, MBA, Bernard S. Black JD, Ali Moghtaderi PhD
{"title":"In reply","authors":"Jesse M. Pines MD, MBA, Bernard S. Black JD, Ali Moghtaderi PhD","doi":"10.1016/j.annemergmed.2024.06.002","DOIUrl":"10.1016/j.annemergmed.2024.06.002","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"84 5","pages":"Pages 600-601"},"PeriodicalIF":5.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1016/j.annemergmed.2024.09.001
Kyle Smiley,Joshua Lowe,Brit Long
{"title":"Does Andexanet Alpha Improve Outcomes Compared With Four-Factor Prothrombin Complex Concentrate for Reversal of Direct Oral Anticoagulants?","authors":"Kyle Smiley,Joshua Lowe,Brit Long","doi":"10.1016/j.annemergmed.2024.09.001","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.09.001","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"28 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1016/j.annemergmed.2024.08.508
Sriram Ramgopal,Oluwakemi Badaki-Makun,Mohamed Eltorki,Pradip Chaudhari,Timothy T Phamduy,Daniel Shapiro,Chris A Rees,Kelly R Bergmann,Mark I Neuman,Douglas Lorenz,Kenneth A Michelson
STUDY OBJECTIVETo evaluate for increases in the use and costs of respiratory viral testing in pediatric emergency departments (EDs) because of the COVID-19 pandemic.METHODSWe performed a cross-sectional study using the pediatric health information system. Eligible subjects were children (90 days to 18 years) who were discharged from a pediatric ED and included in the pediatric health information system from October 2016 through March 2024. To evaluate for changes in the frequency and costs of respiratory viral testing, we performed an interrupted time series analysis across 3 study periods: prepandemic (October 1, 2016 to March 14, 2020), early pandemic (March 15, 2020 to December 31, 2023), and late pandemic (January 1, 2023 to March 31, 2024).RESULTSWe included 15,261,939 encounters from 34 pediatric EDs over the 90-month study period. At least 1 viral respiratory test was performed for 460,826 of 7,311,177 prepandemic encounters (6.3%), 1,240,807 of 5,100,796 early pandemic encounters (24.3%), and 545,696 of 2,849,966 late pandemic encounters (19.1%). There was a positive prepandemic slope in viral testing (0.17% encounters/month; 95% CI 0.17 to 0.18). The early pandemic was associated with a shift change of 4.98% (95% CI 4.90 to 5.07) and a positive slope (0.54% encounters/month; 95% CI 0.54 to 0.55). The late pandemic period was associated with a negative shift (-17.80%; 95% CI -17.90 to -17.70) and a positive slope (0.42% encounters/month; 95% CI 0.41 to 0.42). The slope in testing costs increased from $5,000/month (95% CI $4,200 to $5,700) to $33,000/month (95% CI $32,000 to $34,000) during the early pandemic.CONCLUSIONRespiratory testing and associated costs increased during the COVID-19 pandemic and were sustained despite decreasing incidence of disease. These findings highlight a need for further efforts to clarify indications for viral testing in the ED and efforts to reduce low-value testing.
{"title":"Trends in Respiratory Viral Testing in Pediatric Emergency Departments Following the COVID-19 Pandemic.","authors":"Sriram Ramgopal,Oluwakemi Badaki-Makun,Mohamed Eltorki,Pradip Chaudhari,Timothy T Phamduy,Daniel Shapiro,Chris A Rees,Kelly R Bergmann,Mark I Neuman,Douglas Lorenz,Kenneth A Michelson","doi":"10.1016/j.annemergmed.2024.08.508","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.08.508","url":null,"abstract":"STUDY OBJECTIVETo evaluate for increases in the use and costs of respiratory viral testing in pediatric emergency departments (EDs) because of the COVID-19 pandemic.METHODSWe performed a cross-sectional study using the pediatric health information system. Eligible subjects were children (90 days to 18 years) who were discharged from a pediatric ED and included in the pediatric health information system from October 2016 through March 2024. To evaluate for changes in the frequency and costs of respiratory viral testing, we performed an interrupted time series analysis across 3 study periods: prepandemic (October 1, 2016 to March 14, 2020), early pandemic (March 15, 2020 to December 31, 2023), and late pandemic (January 1, 2023 to March 31, 2024).RESULTSWe included 15,261,939 encounters from 34 pediatric EDs over the 90-month study period. At least 1 viral respiratory test was performed for 460,826 of 7,311,177 prepandemic encounters (6.3%), 1,240,807 of 5,100,796 early pandemic encounters (24.3%), and 545,696 of 2,849,966 late pandemic encounters (19.1%). There was a positive prepandemic slope in viral testing (0.17% encounters/month; 95% CI 0.17 to 0.18). The early pandemic was associated with a shift change of 4.98% (95% CI 4.90 to 5.07) and a positive slope (0.54% encounters/month; 95% CI 0.54 to 0.55). The late pandemic period was associated with a negative shift (-17.80%; 95% CI -17.90 to -17.70) and a positive slope (0.42% encounters/month; 95% CI 0.41 to 0.42). The slope in testing costs increased from $5,000/month (95% CI $4,200 to $5,700) to $33,000/month (95% CI $32,000 to $34,000) during the early pandemic.CONCLUSIONRespiratory testing and associated costs increased during the COVID-19 pandemic and were sustained despite decreasing incidence of disease. These findings highlight a need for further efforts to clarify indications for viral testing in the ED and efforts to reduce low-value testing.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"6 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1016/j.annemergmed.2024.08.513
Kyle M DeWitt,Alicia E Mattson
{"title":"Sugammadex Should Not be Used to Routinely Reverse Rocuronium for Patients in the Emergency Department.","authors":"Kyle M DeWitt,Alicia E Mattson","doi":"10.1016/j.annemergmed.2024.08.513","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.08.513","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"1 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-15DOI: 10.1016/j.annemergmed.2024.08.004
Felipe Teran,Clark G Owyang,Trenton C Wray,John E Hipskind,Justine Lessard,William Bédard Michel,Chantal Lanthier,Peiman Nazerian,Eleonora de Villa,Jonathan Nogueira,Daniel Doynow,Michelle Clinton,Frank Myslik,Ross Prager,Robert Arntfield,Pedro D Salinas,Vladyslav Dieiev,Michael Y Woo,Rajiv Thavanathan,Graeme Puskas,Karan Singh,Priyanka Bhat,Jackson Horn,Brian M Buchanan,Nadia Baig,Katharine M Burns,Kelsey Kennedy,Lawrence Haines,Leily Naraghi,Harpriya Singh,Michael Secko,Daniel Singer,Maria Taylor,John M Joyce,Stephanie DeMasi,Zan M Jafry,Tammy Phan,Natalie Truong,Evan Robinson,Korbin H Haycock,Allyson Hansen,Charlotte Derr,Frances M West,Mangala Narasimhan,James Horowitz,Asad Usman,Kenton L Anderson,Yifan Peng,Philippe Rola,Phillip Andrus,Junaid Razzak,Hugh C Hemmings,Rohan Panchamia,Joanna Palasz,Aarthi Kaviyarasu,Nathaniel A Sands,Robert M Sutton,Benjamin S Abella,
STUDY OBJECTIVETo evaluate the clinical effect, safety, and clinical outcomes of focused transesophageal echocardiography (TEE) in the evaluation of critically ill patients in the emergency department (ED) and ICUs.METHODSWe established a prospective, multicenter, observational registry involving adult critically ill patients in whom focused TEE was performed for evaluation of out-of-hospital cardiac arrest (OHCA), inhospital cardiac arrest, evaluation of undifferentiated shock, hemodynamic monitoring, and/or procedural guidance in the ED, ICU, or operating room setting. The primary objective of the current investigation was to evaluate the clinical influence and safety of focused, point-of-care TEE in critically ill patients. Data elements included patient and procedure characteristics, laboratory values, timing of interventions, clinical outcomes, and TEE video images.RESULTSA total of 1,045 focused TEE studies were collected among 916 patients from 28 hospitals, including 585 (64%) intraarrest and postarrest OHCA and inhospital cardiac arrest, 267 (29%) initial evaluation of undifferentiated shock, 101 (11%) procedural guidance, and 92 (10%) hemodynamic monitoring. TEE changed management in 85% of patients with undifferentiated shock, 71% of patients with inhospital cardiac arrest, and 62% of patients with OHCA. There were no reported esophageal perforations or oropharyngeal injuries, and other procedural complications were rare.CONCLUSIONSA prospective, multicenter, and multidisciplinary TEE registry was successfully implemented, and demonstrated that focused TEE is safe and clinically impactful across multiple critical care applications. Further studies from this research network will accelerate the development of outcome-oriented research and knowledge translation on the use of TEE in emergency and critical care settings.
研究目的评估聚焦经食道超声心动图 (TEE) 在评估急诊科 (ED) 和重症监护室重症患者时的临床效果、安全性和临床结局。方法我们建立了一个前瞻性、多中心、观察性登记处，涉及在急诊科、重症监护室或手术室环境中进行聚焦经食道超声心动图检查以评估院外心脏骤停 (OHCA)、院内心脏骤停、未分化休克评估、血流动力学监测和/或程序指导的成年重症患者。本次调查的主要目的是评估重症患者集中式床旁 TEE 的临床影响和安全性。结果从 28 家医院的 916 名患者中共收集到 1045 次聚焦 TEE 研究，其中包括 585 例（64%）骤停中和骤停后 OHCA 以及院内心脏骤停患者、267 例（29%）未分化休克初步评估患者、101 例（11%）程序指导患者以及 92 例（10%）血液动力学监测患者。TEE 改变了 85% 未分化休克患者、71% 院内心脏骤停患者和 62% OHCA 患者的治疗方案。没有食管穿孔或口咽损伤的报告，其他程序并发症也很少发生。结论成功实施了前瞻性、多中心和多学科 TEE 注册，并证明了聚焦 TEE 在多种重症监护应用中是安全和具有临床影响力的。该研究网络的进一步研究将加速急诊和重症监护环境中使用 TEE 的成果导向型研究和知识转化的发展。
{"title":"Development and Implementation of a Multicenter Registry for Resuscitation-Focused Transesophageal Echocardiography.","authors":"Felipe Teran,Clark G Owyang,Trenton C Wray,John E Hipskind,Justine Lessard,William Bédard Michel,Chantal Lanthier,Peiman Nazerian,Eleonora de Villa,Jonathan Nogueira,Daniel Doynow,Michelle Clinton,Frank Myslik,Ross Prager,Robert Arntfield,Pedro D Salinas,Vladyslav Dieiev,Michael Y Woo,Rajiv Thavanathan,Graeme Puskas,Karan Singh,Priyanka Bhat,Jackson Horn,Brian M Buchanan,Nadia Baig,Katharine M Burns,Kelsey Kennedy,Lawrence Haines,Leily Naraghi,Harpriya Singh,Michael Secko,Daniel Singer,Maria Taylor,John M Joyce,Stephanie DeMasi,Zan M Jafry,Tammy Phan,Natalie Truong,Evan Robinson,Korbin H Haycock,Allyson Hansen,Charlotte Derr,Frances M West,Mangala Narasimhan,James Horowitz,Asad Usman,Kenton L Anderson,Yifan Peng,Philippe Rola,Phillip Andrus,Junaid Razzak,Hugh C Hemmings,Rohan Panchamia,Joanna Palasz,Aarthi Kaviyarasu,Nathaniel A Sands,Robert M Sutton,Benjamin S Abella,","doi":"10.1016/j.annemergmed.2024.08.004","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.08.004","url":null,"abstract":"STUDY OBJECTIVETo evaluate the clinical effect, safety, and clinical outcomes of focused transesophageal echocardiography (TEE) in the evaluation of critically ill patients in the emergency department (ED) and ICUs.METHODSWe established a prospective, multicenter, observational registry involving adult critically ill patients in whom focused TEE was performed for evaluation of out-of-hospital cardiac arrest (OHCA), inhospital cardiac arrest, evaluation of undifferentiated shock, hemodynamic monitoring, and/or procedural guidance in the ED, ICU, or operating room setting. The primary objective of the current investigation was to evaluate the clinical influence and safety of focused, point-of-care TEE in critically ill patients. Data elements included patient and procedure characteristics, laboratory values, timing of interventions, clinical outcomes, and TEE video images.RESULTSA total of 1,045 focused TEE studies were collected among 916 patients from 28 hospitals, including 585 (64%) intraarrest and postarrest OHCA and inhospital cardiac arrest, 267 (29%) initial evaluation of undifferentiated shock, 101 (11%) procedural guidance, and 92 (10%) hemodynamic monitoring. TEE changed management in 85% of patients with undifferentiated shock, 71% of patients with inhospital cardiac arrest, and 62% of patients with OHCA. There were no reported esophageal perforations or oropharyngeal injuries, and other procedural complications were rare.CONCLUSIONSA prospective, multicenter, and multidisciplinary TEE registry was successfully implemented, and demonstrated that focused TEE is safe and clinically impactful across multiple critical care applications. Further studies from this research network will accelerate the development of outcome-oriented research and knowledge translation on the use of TEE in emergency and critical care settings.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"104 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-15DOI: 10.1016/j.annemergmed.2024.04.015
Megan A Rech,Michael Gottlieb
{"title":"SUGAMMADEX SHOULD BE USED TO REVERSE ROCURONIUM IN EMERGENCY DEPARTMENT PATIENTS WITH NEUROLOGIC INJURIES.","authors":"Megan A Rech,Michael Gottlieb","doi":"10.1016/j.annemergmed.2024.04.015","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.04.015","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"231 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-08DOI: 10.1016/j.annemergmed.2024.08.509
Stephanie C DeMasi,Wesley H Self,Neil R Aggarawal,Michael D April,Luke Andrea,Christopher R Barnes,Jason Brainard,Veronika Blinder,Alon Dagan,Brian Driver,Kevin C Doerschug,Ivor Douglas,Matthew Exline,Daniel G Fein,John P Gaillard,Sheetal Gandotra,Kevin W Gibbs,Adit A Ginde,Stephen J Halliday,Jin H Han,Taylor Herbert,Kevin High,Christopher G Hughes,Akram Khan,Andrew J Latimer,Amelia W Maiga,Steven H Mitchell,Amelia L Muhs,Amira Mohamed,Ari Moskowitz,David B Page,Jessica A Palakshappa,Matthew E Prekker,Edward T Qian,Dan Resnick-Ault,Todd W Rice,Derek W Russel,Steven G Schauer,Kevin P Seitz,Nathan I Shapiro,Lane M Smith,Peter Sottile,Susan Stempek,Stacy A Trent,Derek J Vonderhaar,James E Walker,Li Wang,Micah R Whitson,Jonathan D Casey,Matthew W Semler,
STUDY OBJECTIVETo examine the association between the neuromuscular blocking agent received (succinylcholine versus rocuronium) and the incidences of successful intubation on the first attempt and severe complications during tracheal intubation of critically ill adults in an emergency department (ED) or ICU.METHODSWe performed a secondary analysis of data from 2 multicenter randomized trials in critically ill adults undergoing tracheal intubation in an ED or ICU. Using a generalized linear mixed-effects model with prespecified baseline covariates, we examined the association between the neuromuscular blocking agent received (succinylcholine versus rocuronium) and the incidences of successful intubation on the first attempt (primary outcome) and severe complications during tracheal intubation (secondary outcome).RESULTSAmong the 2,440 patients in the trial data sets, 2,339 (95.9%) were included in the current analysis; 475 patients (20.3%) received succinylcholine and 1,864 patients (79.7%) received rocuronium. Successful intubation on the first attempt occurred in 375 patients (78.9%) who received succinylcholine and 1,510 patients (81.0%) who received rocuronium (an adjusted odds ratio of 0.87; 95% CI 0.65 to 1.15). Severe complications occurred in 67 patients (14.1%) who received succinylcholine and 456 patients (24.5%) who received rocuronium (adjusted odds ratio, 0.88; 95% CI 0.62 to 1.26).CONCLUSIONAmong critically ill adults undergoing tracheal intubation, the incidences of successful intubation on the first attempt and severe complications were not significantly different between patients who received succinylcholine and patients who received rocuronium.
{"title":"Association Between Neuromuscular Blocking Agents and Outcomes of Emergency Tracheal Intubation: A Secondary Analysis of Randomized Trials.","authors":"Stephanie C DeMasi,Wesley H Self,Neil R Aggarawal,Michael D April,Luke Andrea,Christopher R Barnes,Jason Brainard,Veronika Blinder,Alon Dagan,Brian Driver,Kevin C Doerschug,Ivor Douglas,Matthew Exline,Daniel G Fein,John P Gaillard,Sheetal Gandotra,Kevin W Gibbs,Adit A Ginde,Stephen J Halliday,Jin H Han,Taylor Herbert,Kevin High,Christopher G Hughes,Akram Khan,Andrew J Latimer,Amelia W Maiga,Steven H Mitchell,Amelia L Muhs,Amira Mohamed,Ari Moskowitz,David B Page,Jessica A Palakshappa,Matthew E Prekker,Edward T Qian,Dan Resnick-Ault,Todd W Rice,Derek W Russel,Steven G Schauer,Kevin P Seitz,Nathan I Shapiro,Lane M Smith,Peter Sottile,Susan Stempek,Stacy A Trent,Derek J Vonderhaar,James E Walker,Li Wang,Micah R Whitson,Jonathan D Casey,Matthew W Semler,","doi":"10.1016/j.annemergmed.2024.08.509","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.08.509","url":null,"abstract":"STUDY OBJECTIVETo examine the association between the neuromuscular blocking agent received (succinylcholine versus rocuronium) and the incidences of successful intubation on the first attempt and severe complications during tracheal intubation of critically ill adults in an emergency department (ED) or ICU.METHODSWe performed a secondary analysis of data from 2 multicenter randomized trials in critically ill adults undergoing tracheal intubation in an ED or ICU. Using a generalized linear mixed-effects model with prespecified baseline covariates, we examined the association between the neuromuscular blocking agent received (succinylcholine versus rocuronium) and the incidences of successful intubation on the first attempt (primary outcome) and severe complications during tracheal intubation (secondary outcome).RESULTSAmong the 2,440 patients in the trial data sets, 2,339 (95.9%) were included in the current analysis; 475 patients (20.3%) received succinylcholine and 1,864 patients (79.7%) received rocuronium. Successful intubation on the first attempt occurred in 375 patients (78.9%) who received succinylcholine and 1,510 patients (81.0%) who received rocuronium (an adjusted odds ratio of 0.87; 95% CI 0.65 to 1.15). Severe complications occurred in 67 patients (14.1%) who received succinylcholine and 456 patients (24.5%) who received rocuronium (adjusted odds ratio, 0.88; 95% CI 0.62 to 1.26).CONCLUSIONAmong critically ill adults undergoing tracheal intubation, the incidences of successful intubation on the first attempt and severe complications were not significantly different between patients who received succinylcholine and patients who received rocuronium.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"38 4 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142436114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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