Etomidate or ketamine? The debate over the ideal agent for emergency rapid sequence intubation (RSI) has raged for years with no clear winner. Etomidate has been touted in the past for its rapid onset and minimal intrinsic effects on hemodynamics. However, the drug is well known as a transient adrenal suppressant though the impact of this suppression isn’t clear. Ketamine has risen in recent years as an alternative, due to its perceived hemodynamic stability, analgesic properties and absence of adrenal suppression. Additionally, recent data points towards improved mortality when ketamine was selected over etomidate (Kotani 2023). High quality randomized controlled trials are needed to further elucidate which agent should be selected in critically ill patients.
The post The RSI Trial: Ketamine vs Etomidate in Rapid Sequence Intubation appeared first on REBEL EM – Emergency Medicine Blog.
The RSI Trial investigated the use of ketamine versus etomidate for induction during rapid sequence intubation in adult patients in emergency departments and intensive care units. This was a multicenter, randomized controlled trial.
The primary outcome for the study was first pass intubation success without the occurrence of hypoxemia, defined as an oxygen saturation below 90 percent, or hypotension, defined as a systolic blood pressure below 90 mmHg.
The trial found no significant difference between ketamine and etomidate concerning this primary outcome. First pass success without hypoxemia or hypotension was achieved in 62.7 percent of patients receiving ketamine and 60.1 percent of patients receiving etomidate. This indicates that ketamine was non-inferior to etomidate for this specific endpoint.
For various secondary outcomes, no significant differences were observed between the two drug groups. These secondary outcomes included overall first pass intubation success, the incidence of hypoxemia, the incidence of hypotension, the occurrence of serious adverse events, hospital length of stay, intensive care unit length of stay, and 28-day mortality.
The study population consisted of critically ill patients, and adverse events such as hypoxemia and hypotension were common in both treatment groups, reflecting the high acuity of the patients involved. The trial was stopped earlier than planned due to recruitment difficulties and the COVID-19 pandemic, which might impact the ability to detect differences in less common outcomes.
In summary, the trial results suggest that both ketamine and etomidate are comparable and acceptable options for induction in rapid sequence intubation when considering first pass success without specific complications and other important clinical outcomes. The choice between these medications can be based on individual patient characteristics and the clinician’s preference.
https://rebelem.com/the-rsi-trial-ketamine-vs-etomidate-in-rapid-sequence-intubation/?utm_source=rss&utm_medium=rss&utm_campaign=the-rsi-trial-ketamine-vs-etomidate-in-rapid-sequence-intubation
