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Effect of patient weight on first pass success and neuromuscular blocking agent dosing for rapid sequence intubation in the emergency department
  1. Asad E Patanwala1,
  2. John C Sakles2
  1. 1 Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson, Arizona, USA
  2. 2 Department of Emergency Medicine, College of Medicine, The University of Arizona, Tucson, Arizona, USA
  1. Correspondence to Dr Asad E Patanwala, 1295 N. Martin, PO Box 210202, Tucson, AZ 85721, USA; patanwala{at}


Objectives The primary objective of this study was to determine the association between patient weight and first pass success (FPS) during rapid sequence intubation (RSI) in the ED. The secondary objective was to evaluate the association between patient weight and neuromuscular blocking agent (NMBA) dosing.

Methods This was a retrospective cohort study conducted in a tertiary care academic ED. Consecutive adult patients who underwent RSI in the ED between January 2014 and June 2016 were included. Data were collected on patient, operator and procedural characteristics. The cohort was categorised into the following weight strata: <80 kg, 80 to <100 kg, 100 to <120 kg and ≥120 kg. The primary outcome of interest was FPS. A multivariable logistic regression analysis was conducted to evaluate the relationship between patient weight category and FPS. NMBA dosing was reported descriptively.

Results The sample included 891 patients. FPS for each weight category was as follows: <80 kg (91%), 80 to <100 kg (90%), 100 to <120 kg (91%) and ≥120 kg (76%). After adjusting for potential confounders, the heaviest weight category was associated with decreased odds of FPS (OR 0.2, 95% CI 0.1 to 0.5, p<0.001). Median doses for succinylcholine (based on total body weight) decreased as weight increased: <80 kg (1.5 mg/kg), 80 to <100 kg (1.3 mg/kg), 100 to <120 kg (1.2 mg/kg) and ≥120 kg (1.0 mg/kg). Median doses for rocuronium (based on ideal body weight) were similar across weight categories: <80 kg (1.3 mg/kg), 80 to <100 kg (1.4 mg/kg), 100 to <120 kg (1.3 mg/kg) and ≥120 kg (1.4 mg/kg).

Conclusions Very heavy patients (>120 kg) undergoing RSI in the ED had a reduced FPS, and succinylcholine was more commonly underdosed than rocuronium in the heavier weight group.

  • intratracheal intubation
  • hospital emergency service
  • succinylcholine
  • neuromuscular nondepolarizing agents
  • obesity

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  • Contributors Both authors equally contributed to the conception and design of the study, interpreted the data and approved the final manuscript. AEP conducted the data analysis and wrote the first draft of the manuscript. JCS acquired the data and contributed to its revision.

  • Competing interests JCS serves as a consultant to Verathon.

  • Ethics approval Institutional Review Board of the University of Arizona.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There is no additional unpublished data that is not included in the manuscript. Readers may contact the authors for desired information.