Authors: Sarah K S Knack, Matthew E Prekker, Johanna C Moore, Lauren R Klein, Alexandra H Atkins, James R Miner, Brian E Driver
Journal: Journal of Emergency Medicine
Publication Date: June 21, 2023
Conclusions:
- No significant differences were observed in maximum SOFA score or incidence of post-intubation hypotension between critically ill adults receiving ketamine vs. etomidate for RSI.
Objective:
- The study aimed to compare the effects of a single dose of ketamine vs. etomidate for RSI on maximum Sequential Organ Failure Assessment (SOFA) score and the incidence of hypotension.
Methods:
- A single-center, randomized, parallel-group trial was conducted, comparing ketamine and etomidate for RSI in critically ill adult patients in the emergency department.
- The trial operated under Exception from Informed Consent.
- The primary outcome was the maximum SOFA score within the first 3 days of hospitalization.
Results:
- A total of 143 patients participated, with 70 in the ketamine group and 73 in the etomidate group.
- Maximum median SOFA scores were 6.5 (IQR 5-9) for ketamine and 7 (IQR 5-9) for etomidate, with no significant difference (p = 0.79).
- Post-intubation hypotension occurred in 28% of the ketamine group and 26% of the etomidate group (difference 2%, 95% CI -13% to 17%).
- Intensive care unit outcomes showed no significant differences between the groups.
- Thirty-day mortality rates were 11% for the ketamine group and 21% for the etomidate group, without statistical difference.
Knack, S.K., Prekker, M.E., Moore, J.C., Klein, L.R., Atkins, A.H., Miner, J.R. and Driver, B.E., 2023. The Effect of Ketamine Versus Etomidate for Rapid Sequence Intubation on Maximum Sequential Organ Failure Assessment Score: A Randomized Clinical Trial. The Journal of Emergency Medicine, pp.S0736-4679.