The EMS Lighthouse Project

We were all taught succinylcholine is contraindicated in hyperkalemia because it can cause potassium release, exacerbating the problem. But does it? Does it really?

Dr. Jarvis discusses a recent paper that seems to compare mortality within 24 hours of RSI in hyperkalemic patients between those intubated with succ or rocuronium. And then we discuss methods.. including the Table 1 Fallacy. 

Citations:

1.     Simmer PE, Perza M, Cho YD, et al.: Hyperkalemic emergency department patients intubated with rocuronium or succinylcholine: Retrospective study of clinical outcomes. The American Journal of Emergency Medicine. 2026; February;100:154–64.

2.     Cole JB, Knack SKS, Driver BE: The value of P-values in “Table 1.” The American Journal of Emergency Medicine. 2026; February;100:182–6.

3.     Pappal RD, Roberts BW, Mohr NM, et al.: The ED-AWARENESS Study: A Prospective, Observational Cohort Study of Awareness With Paralysis in Mechanically Ventilated Patients Admitted From the Emergency Department. Ann Emerg Med. 2021;77(5):532–44.

4.     ‘Rick & Jerry’ Pass the Baton | Emergency Physicians Monthly. Available at https://epmonthly.com/article/rick-jerry-pass-the-baton/. Accessed January 25, 2026.