Spoon Feed
There was no difference in 28-day mortality in critically ill adult patients with ketamine vs. etomidate for rapid sequence induction (RSI), but ketamine increased the need for peri-intubation vasopressor support.

Watch the pendulum swing…
Etomidate causes early adrenal suppression. Ketamine may cause hypotension during induction. Observational studies have been back and forth on which is the better drug for RSI.

This was a multicenter RCT with 2,365 critically ill adult patients randomized to ketamine or etomidate for RSI. For the primary outcome of in-hospital 28-day mortality, there was no difference between the two groups: 28.1% (330/1173) ketamine vs. 29.1% (345/1,186) etomidate cohorts (–0.8% (95%CI −4.5 to 2.9, p = 0.65). But there was a big difference in the number of patients with cardiovascular (CV) collapse (SBP <65, new vasopressors, arrest) within 2 minutes of intubation: 22.1% (260/1,176) ketamine vs. 17% (202/1,189) etomidate cohort (difference 5.1% 95%CI 1.9 to 8.3), largely driven by new vasopressors. In subgroup analysis, CV collapse was even more pronounced in septic shock patients: 30.6% ketamine vs. 20.9% etomidate group (difference 9.7%; 95%CI 4.6 to 14.9).

Outlet: JournalFeed