Ketamine vs. Etomidate for Rapid Sequence Intubation

An observational study suggests that these two agents are similarly safe but sends a possibly worrisome signal.

Several studies have sought — and failed to find — evidence that etomidate is bad for patients due to the adrenal suppression it is known to cause (NEJM JW Emerg Med Mar 2014 and Anesth Analg 2013; 117:1329). Meanwhile, ketamine has emerged as an attractive alternative (NEJM JW Emerg Med Feb 2013 and J Trauma Acute Care Surg 2012; 73:1401). These investigators evaluated patient outcomes at one academic Level I trauma center before and after an institutional switch from etomidate to ketamine as the principal agent for rapid sequence intubation.

They compared 526 patients who received etomidate before the protocol change with 442 who received ketamine after the protocol change. In-hospital mortality (the main outcome), and the number of intens…

Reviewing Author

Daniel J. Pallin, MD, MPH

Disclosures

Consultant/Advisory BoardPortola Pharmaceuticals, Inc.

Speaker’s BureauPeerView Institute for Medical Education

Grant/Research SupportAgency for Healthcare Research and Quality; CDC; NIH–National Center for Advancing Translational Sciences; NIH–National Institute of Allergy and Infectious Diseases (NIAID); NIH–NIAID–Antibacterial Resistance Leadership Group; Merck; Pfizer; Boehringer-Ingelheim; Shire; Portola Pharmaceuticals, Inc.; Novartis; bioMérieux; Siemens; Rapid Pathogen Screening; Magnolia; Stago; Innovative Biosensors; Molecular Detection, Inc.; Dyax Corp.; Trius Pharmaceuticals

Daniel J. Pallin, MD, MPH

Disclosures

Consultant/Advisory BoardPortola Pharmaceuticals, Inc.

Speaker’s BureauPeerView Institute for Medical Education

Ketamine vs. Etomidate for Rapid Sequence Intubation

Topics

Reviewing Author