Ketamine versus etomidate for rapid sequence intubation in patients with trauma: a retrospective study in a level 1 trauma center in Korea.

Publisher: BioMed Central Country of Publication: England NLM ID: 100968543 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-227X (Electronic) Linking ISSN: 1471227X NLM ISO Abbreviation: BMC Emerg Med Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Etomidate*/therapeutic use ; Ketamine*/therapeutic use; Humans ; Retrospective Studies ; Anesthetics, Intravenous/adverse effects ; Rapid Sequence Induction and Intubation ; Trauma Centers ; Intubation, Intratracheal ; Republic of Korea

Background: Ketamine and etomidate are commonly used as sedatives in rapid sequence intubation (RSI). However, there is no consensus on which agent should be favored when treating patients with trauma. This study aimed to compare the effects of ketamine and etomidate on first-pass success and outcomes of patients with trauma after RSI-facilitated emergency intubation.
Methods: We retrospectively reviewed 944 patients who underwent endotracheal intubation in a trauma bay at a Korean level 1 trauma center between January 2019 and December 2021. Outcomes were compared between the ketamine and etomidate groups after propensity score matching to balance the overall distribution between the two groups.
Results: In total, 620 patients were included in the analysis, of which 118 (19.9%) were administered ketamine and the remaining 502 (80.1%) were treated with etomidate. Patients in the ketamine group showed a significantly faster initial heart rate (105.0 ± 25.7 vs. 97.7 ± 23.6, p = 0.003), were more hypotensive (114.2 ± 32.8 mmHg vs. 139.3 ± 34.4 mmHg, p < 0.001), and had higher Glasgow Coma Scale (9.1 ± 4.0 vs. 8.2 ± 4.0, p = 0.031) and Injury Severity Score (32.5 ± 16.3 vs. 27.0 ± 13.3, p < 0.001) than those in the etomidate group. There were no significant differences in the first-pass success rate (90.7% vs. 90.1%, p > 0.999), final mortality (16.1% vs. 20.6, p = 0.348), length of stay in the intensive care unit (days) (8 [4, 15] (Interquartile range)), vs. 10 [4, 21], p = 0.998), ventilator days (4 [2, 10] vs. 5 [2, 13], p = 0.735), and hospital stay (days) (24.5 [10.25, 38.5] vs. 22 [8, 40], p = 0.322) in the 1:3 propensity score matching analysis.
Conclusion: In this retrospective study of trauma resuscitation, those receiving intubation with ketamine had greater hemodynamic instability than those receiving etomidate. However, there was no significant difference in clinical outcomes between patients sedated with ketamine and those treated with etomidate.
(© 2023. The Author(s).)

JAMA. 2000 Feb 23;283(8):1038-45. (PMID: 10697064)
PLoS Med. 2007 Oct 16;4(10):e296. (PMID: 17941714)
J Intensive Care Med. 2013 Nov-Dec;28(6):375-9. (PMID: 22644454)
J Crit Care. 2018 Jun;45:65-70. (PMID: 29413725)
Anesthesiology. 2010 Sep;113(3):678-84. (PMID: 20693870)
Lancet. 2009 Jul 25;374(9686):293-300. (PMID: 19573904)
J Trauma Acute Care Surg. 2012 Nov;73(5 Suppl 4):S333-40. (PMID: 23114490)
Arch Surg. 2008 Jan;143(1):62-7; discussion 67. (PMID: 18209154)
Anesthesiology. 1992 Apr;76(4):564-72. (PMID: 1550282)
Acad Emerg Med. 2020 Nov;27(11):1106-1115. (PMID: 32592205)
J Trauma. 2009 Jul;67(1):45-50. (PMID: 19590307)
Ann Emerg Med. 2015 Apr;65(4):363-370.e1. (PMID: 25533140)
Scand J Trauma Resusc Emerg Med. 2021 Sep 15;29(1):136. (PMID: 34526085)
Can J Anaesth. 2014 Jul;61(7):650-5. (PMID: 24723214)
Crit Care. 2015 Apr 01;19:134. (PMID: 25879683)
J Emerg Med. 1997 Mar-Apr;15(2):221-30. (PMID: 9144065)
Anaesthesia. 2001 Mar;56(3):266-71. (PMID: 11251436)
Intensive Care Med. 2022 Jan;48(1):78-91. (PMID: 34904190)

Keywords: Etomidate; Ketamine; Rapid sequence intubation; Resuscitation; Trauma

Z22628B598 (Etomidate)
690G0D6V8H (Ketamine)
0 (Anesthetics, Intravenous)

Date Created: 20230529 Date Completed: 20230531 Latest Revision: 20230601

20250114

PMC10228132

10.1186/s12873-023-00833-7

37248552