A17-03 Effect of Ketamine vs Etomidate on Cardiovascular Collapse During Tracheal Intubation of Critically Ill Adults: A Secondary Analysis of the RSI Trial
Abstract
Ketamine and etomidate are medications commonly used to induce anesthesia for emergency tracheal intubation of critically ill adults in many emergency departments (EDs) and intensive care units (ICUs). How the choice between ketamine and etomidate affects patients’ hemodynamics during intubation remains uncertain.
The Randomized Trial of Sedative Choice for Intubation (RSI) compared the use of ketamine vs etomidate with regard to in-hospital mortality at 28-days among 2,365 patients from 14 EDs or ICUs. The primary analysis of the RSI trial evaluating the effect of induction medications on mortality included only the initial (index) intubation for each patient. This secondary analysis evaluating the effect of induction medications on hemodynamics during intubation included any intubations for a patient for which the trial determined the induction medication by randomization. The primary outcome was cardiovascular collapse during intubation, defined as a systolic blood pressure < 65 mm Hg, new or increased vasopressors, or cardiac arrest between induction of anesthesia and 2 minutes after tracheal intubation. Exploratory outcomes included a systolic blood pressure < 90 mm Hg during intubation.
Among 2,365 patients in the RSI trial, a total of 2,535 intubations occurred, of which 1,268 were randomized to the ketamine group and 1,267 were randomized to the etomidate group. At the time of induction, the median systolic blood pressure was 126 mm Hg (interquartile range, 109-147)…
How strong is the evidence?
Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 2,365 participants or records.
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