EM-RAP : Abstract 1: Ketamine or Etomidate for Intubation of Critically Ill Adults

Feb 2026

Outlet: EM-RAP

SUMMARY:

Many articles have compared etomidate vs ketamine as induction agents for rapid sequence intubation (RSI), and the retrospective and prospective trial data have shown mixed results. A major concern is etomidate’s effects on the adrenal glands. Laboratory testing has indicated that etomidate affects markers of adrenal function, even when administered as a single dose; however, real effects on clinical outcomes have been much more difficult to demonstrate. We have recently covered a massive retrospective study on the topic, which reported a 3% absolute increase in mortality with etomidate use in a 40,000-patient outcome cohort, but this finding was almost certainly influenced by unmeasured but highly relevant confounders.

The Pragmatic Critical Care Research Group (PCCRG) is a network of emergency medicine, anesthesiology, and critical care clinicians and researchers at more than 25 hospitals across the United States that embeds pragmatic trials within clinical care to improve outcomes for acutely ill patients.