Ketamine vs. Etomidate for Emergent Intubation

Etomidate has long been favored for rapid sequence intubation (RSI) due to its quick onset and presumed hemodynamic neutrality. But concerns about adrenal suppression, especially in sepsis, have led many clinicians to choose ketamine instead, hoping to benefit from its catecholamine surge to support blood pressure.

In this multicenter U.S. trial, 2400 adults undergoing RSI in emergency departments and ICUs were randomized to receive ketamine or etomidate (see Figure 1). Cardiovascular events, including hypotension and arrhythmias, were closely tracked around the time of intubation.