Use of neuromuscular blocking agents in prehospital medicine: Practice survey in Emergency Mobile Services of the South-East of France

Objective. - To evaluate the use of neuromuscular blocking agents (NMBA) in the French adult Prehospital Emergency Medical Services (PEMS). Study design. - Telephone survey of practices. Materials and methods. - A survey was conducted from April to July 2009 in every PEMS of the South-East of France. A PEMS physician by center was interviewed using a standardized quiz including demographic data, methods of anesthetic induction, use of NMBA and succinylcholine. Results. - All 86 EMS were interviewed. Succinylcholine was used in 98% of cases for rapid sequence induction. Nondepolarizing NMBA were never used by 38%. They were not available in 21% of PEMS. Among the practitioners using them, 79% prescribed them rarely (less than 25% of incubated patients). Nondepolarizing NMBA were prescribed in more than half of cases of patient ventilator asynchrony by 27% of physicians, of ventilator high pressure (23%), of acute status asthmaticus (23%), of suspicion of intracranial hypertension (22%), of refractory hypoxemia (16%), therapeutic hypothermia (10%). Limitations of prescription were essentially little guidance and lack of training. Atracurium and cisatracurium were the most used. The exact dosages were known by only 18% of practitioners. None of the practitioners were performing a monitoring of NMBA. Conclusion. - This survey highlights the very frequent use of succinylcholine for rapid sequence induction and low use of nondepolarizing NMBA for selected indications. A training endeavor could be undertaken to improve the use of these anesthetic drugs by prehospital physicians. (C) 2011 Elsevier Masson SAS. All rights reserved.