6/29/23, 1:10 AM REMICRUSH Pathway Feedback Search Clinical Topics Home Studies REMICRUSH REMICRUSH Trial question Is remifentanil noninferior to a rapid-onset neuromuscular blocker in patients at risk of aspiration during rapid sequence intubation in the operating room? Study design Multi-center Open label RCT Population Characteristics of study participants 50.0% female N = 1150 50.0% male 1150 patients (573 female, 572 male) Inclusion criteria: adults at risk of aspiration who underwent tracheal intubation in the operating room Key exclusion criteria: planned impossible intubation; contraindication to use of succinylcholine and rocuronium; cardiac arrest; preoperative hypoxemia; hemodynamic shock Interventions N=575 remifentanil (an intravenous dose of 3-4 g/kg, immediately after injection of a hypnotic) N=575 neuromuscular blockers (intravenous succinylcholine or rocuronium 1 mg/kg, immediately after injection of a hypnotic) Primary outcome Successful tracheal intubation on first attempt without major complications 71.6 % 71.6 66.1 53.7 % 35.8 % https://web.pathway.md/studies/recl3zjpxLgA7GPGI 1/2 6/29/23, 1:10 AM REMICRUSH Pathway 17.9 % Difference exceeding nonferiority margin 0.0 % Remifentanil Neuromuscular blockers Difference exceeding nonferiority margin in successful tracheal intubation on first attempt without major complications (66.1% vs. 71.6%; AD -6.1%, 95% CI -11.6 to -0.5) Secondary outcomes Significant increase in intubation difficulty scale score (3 vs. 2.7; AD 0.4, 95% CI 0.2 to 0.6) No significant difference in postoperative desaturation 92% (10.3% vs. 9.9%; AD 0.6%, 95% CI -2.7 to 3.9) Safety outcomes No significant difference in severe adverse events and hemodynamic instability. Conclusion In adults at risk of aspiration who underwent tracheal intubation in the operating room, remifentanil was not noninferior to neuromuscular blockers with respect to successful tracheal intubation on first attempt without major complications. Reference Nicolas Grillot, Gilles Lebuffe, Olivier Huet et al. Effect of Remifentanil vs Neuromuscular Blockers During Rapid Sequence Intubation on Successful Intubation Without Major Complications Among Patients at Risk of Aspiration. JAMA. 2023 Jan 3;329(1):28-38. Open reference URL https://web.pathway.md/studies/recl3zjpxLgA7GPGI 2/2