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Cited by 94Airway Management and Intubation TechniquesAnesthesia and Sedative AgentsRespiratory Support and Mechanisms

Comparison of etomidate and ketamine for induction during rapid sequence intubation of adult trauma patients

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Upchurch, Cameron P., Grijalva, Carlos G., Russ, Stephan, Collins, Sean P., Semler, Matthew W., Rice, Todd W., Liu, Dandan, Ehrenfeld, Jesse M. +4 more·2017·Annals of Emergency Medicine
DOI 10.1016/j.annemergmed.2016.08.009PMC PMC5180365
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Abstract

Study objective Induction doses of etomidate during rapid sequence intubation cause transient adrenal dysfunction, but its clinical significance on trauma patients is uncertain. Ketamine has emerged as an alternative for rapid sequence intubation induction. Among adult trauma patients intubated in the emergency department, we compare clinical outcomes among those induced with etomidate and ketamine. Methods The study entailed a retrospective evaluation of a 4-year (January 2011 to December 2014) period spanning an institutional protocol switch from etomidate to ketamine as the standard induction agent for adult trauma patients undergoing rapid sequence intubation in the emergency department of an academic Level I trauma center. The primary outcome was hospital mortality evaluated with multivariable logistic regression, adjusted for age, vital signs, and injury severity and mechanism. Secondary outcomes included ICU-free days and ventilator-free days evaluated with multivariable ordered logistic regression using the same covariates. Results The analysis included 968 patients, including 526 with etomidate and 442 with ketamine. Hospital mortality was 20.4% among patients induced with ketamine compared with 17.3% among those induced with etomidate (adjusted odds ratio [OR] 1.41; 95% confidence interval [CI] 0.92 to 2.16). Patients induced with ketamine had ICU-free days (adjusted OR 0.80; 95% CI 0.63 to 1.00) and ventilator-free days (adjusted OR 0.96; 95% CI 0.76 to 1.20) similar to those of patients induced with etomidate. Conclusion In this analysis spanning an institutional protocol switch from etomidate to ketamine as the standard rapid sequence intubation induction agent for adult trauma patients, patient-centered outcomes were similar for patients who received etomidate and ketamine.

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  • With a favorable hemodynamic profile and strong analgesic effect, ketamine is quickly becoming the preferred induction agent for trauma patients.

    “With a favorable hemodynamic profile and strong analgesic effect, ketamine is quickly becoming the preferred induction agent for trauma patients.100”

    From Airway Management in Trauma (2018) · cites this paper as [100]

    The Introduction (Background and Importance; page unavailable) describes ketamine’s favorable hemodynamic effects and its emergence as an alternative for trauma intubation. It does not discuss a strong analgesic effect or establish that ketamine is becoming the preferred agent generally; the Background says it remains unclear which agent should be preferred, and the Discussion reports no improvement in patient-centered outcomes over etomidate. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • In North America, etomidate has been the most commonly used induction agent used for RSI.

    “In North America, etomidate has been the most commonly used induction agent used for RSI.”

    From Airway Management in Trauma (2018) · cites this paper as [100]

    The Discussion (page unavailable) reports that etomidate was used in more than 90% of emergency-department RSIs recorded by a large multicenter registry, supporting its predominance in that setting. The passage does not establish that it was the most commonly used agent for RSI across all of North America or outside emergency departments. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Owing to the association between using etomidate and adrenal suppression, many institutions have moved to alternative induction agents.

    “Owing to the association between using etomidate and adrenal suppression, many institutions have moved to alternative induction agents.1,100”

    From Airway Management in Trauma (2018) · cites this paper as [100]

    The Introduction (Importance) states that etomidate causes transient adrenal suppression. The Introduction (Goals of This Investigation) says the authors’ institution switched from etomidate to ketamine because of concerns about adrenal dysfunction, but the paper does not establish that many institutions made that switch. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • A study comparing standard full-dose ketamine with etomidate in trauma patients showed no survival benefit of one agent over the other.

    “A study comparing standard full-dose ketamine with etomidate in trauma patients showed no survival benefit of one agent over the other.100”

    From Airway Management in Trauma (2018) · cites this paper as [100]

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Authors
Upchurch, C. P., Grijalva, C. G., Russ, S., Collins, S. P., Semler, M. W., Rice, T. W., Liu, D., Ehrenfeld, J. M., High, K., Barrett, T. W., McNaughton, C. D., & Self, W. H.
Affiliations
Vanderbilt University Medical Center (US)
Corresponding author
Self, Wesley H.
ORCID
Venue
Annals of Emergency Medicine
Publisher
Elsevier BV
Published
2017-01
Volume
69
Issue
1
Pages
24-33.e2
ISSN
0196-0644 (ISSN-L)
DOI
10.1016/j.annemergmed.2016.08.009
PMC
PMC5180365
OpenAlex
W2567430912
Cited by
94
References
4
Citations by year
2026: 4 · 2025: 10 · 2024: 7 · 2023: 14 · 2022: 12 · 2021: 13 · 2020: 12 · 2019: 10 · 2018: 9 · 2017: 3
FWCI
9.32
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Annals of Emergency Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute on Aging (K23GM110469)
  • National Institute of General Medical Sciences (UL1 TR000445)
  • National Center for Advancing Translational Sciences
  • Vanderbilt University (R01AG043471, TL1TR000447)
  • School of Medicine, Vanderbilt University
  • National Institutes of Health
Topics
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
Keywords
etomidate, ketamine, rapid sequence intubation, induction agents, trauma patients, in-hospital mortality, ICU-free days, ventilator-free days, adrenal dysfunction, emergency department airway management
MeSH terms
Adult, Etomidate, Female, Humans, Hypnotics and Sedatives, Intubation, Intratracheal, Ketamine, Male, Middle Aged, Retrospective Studies, Trauma Centers, Wounds and Injuries, Procedural Sedation, Hospital Mortality

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