Long-acting neuromuscular blocker use during pre-hospital transport of critically ill trauma patients

Objectives:

The purpose of this study was to determine the rate of long-acting neuromuscular blocker (NMB) use and evaluate the concurrent use of sedatives in intubated trauma patients during pre-hospital transport. 

Methods:

This was a retrospective cohort study conducted in a tertiary care, academic emergency department. Consecutive adult trauma patients who were intubated in the pre-hospital setting and brought to the emergency department during a two-year period, were included. The primary outcome measure was to determine the rate of long-acting NMB use in these patients. Patients were categorized into two groups: 1) long-acting NMB and 2) no long-acting NMB. The use of post-intubation sedatives was compared between the groups using a Wilcoxon rank-sum test or a Fisher’s exact test for continuous or categorical variables, respectively. 

Results:

A total of 51 patients were included in the final analyses. Of these, 86% (n=44) were given a short-acting NMB (succinylcholine), 10% (n=5) were given a long-acting NMB (rocuronium) and 4% (n=2) were not given any NMB for rapid sequence intubation.  After intubation, 75% (n=38) received an additional long-acting NMB such as vecuronium (n=22) or rocuronium (n=16) to prevent patient movement.  Overall, 82% (n=42) of patients received a long-acting NMB during transport.  There was no difference in the rate of post-intubation sedative use during transport between the long-acting NMB and no long-acting NMB groups (79% versus 67%, respectively, p=0.42).  The long-acting NMB group received sedatives less promptly after intubation compared to those who did not receive a long-acting NMB (16 versus 7 minutes, respectively, p=0.04).  

Conclusion:

The use of long-acting NMB is common during the pre-hospital transport of trauma patients. Some of these patients may not be given sedatives or may have delays in receiving sedatives after intubation.