Both etomidate and ketamine are commonly used as the induction agent for RSI in adult trauma patients. There are concerns about etomidate-associated adrenal suppression leading to complications in critically ill patients. This is a retrospective study comparing the outcome of patients intubated in the ED with etomidate vs. ketamine. There were a total of 968 patients (526 in the etomidate group and 442 in the ketamine group). Exclusions: use of other agent, no induction agent used, both induction agent used, and age< 18. The statistically analysis was adjusted for age, VS, injury severity and mechanism. The study showed no significant difference between hospital mortality between the two groups (etomidate 17.3% vs. ketamine 20.4%, adjusted odds ratio = 1.42 (95% CI 0.92-2.16)). In addition, there was no difference in the two groups for ICU-free days and ventilator-free days.

Take home point: This study found no difference in hospital mortality between etomidate and ketamine. However, given that this study is a prospective study, there may be important cofounders and that ED providers may prefer different agents for different clinical scenario. Thus, further prospective studies should be performed to validate these findings.

Upchurch CP et al. Comparison of etomidate and ketamine for induction during rapid sequence intubation of adult trauma patients. Ann Emerg Med 2017; 69: 24-33. PMID: 27993308