Etomidate or Ketamine to Avoid Peri-Intubation Hypotension?

Single-dose etomidate for emergency intubation is considered hemodynamically stable, but some authors have postulated that ketamine, which induces catecholamine release, may be safer for patients at risk for hypotension.

These authors queried an international, prospective, observational database of emergency department intubations to identify patients ≥14 years old who received ketamine or etomidate as the induction agent and had preprocedural systolic blood pressures between 100 mm and 139 mm Hg. Of 19,071 intubations in the database from 2016 through 2018, 6806 met the inclusion criteria (738 ketamine, 6068 etomidate).

Patients intubated with ketamine were significantly more likely to have difficult airway characteristics (69% vs. 60%), to …