outlet: DH Press Release

outlet: UCD press release 

Outlet: EurekAlert! 

Hennepin Healthcare Research Institute

Doctors treating seriously ill patients in an emergency setting may want to give the sedative etomidate, rather than ketamine, while placing a breathing tube, according to a randomized trial published Dec. 9 in the New England Journal of Medicine.

The Randomized Trial of Sedative Choice for Intubation (RSI) is the first multicenter trial to demonstrate significant cardiovascular risks of high doses of ketamine (low blood pressure, arrhythmia), side effects that have not been well studied in the past.

“We know that patients receive treatments every day in hospitals around the world that have never been evaluated in a rigorous study and may be ineffective or even harmful,” said lead author Jonathan Casey, MD, associate professor of Medicine in the Division of Allergy, Pulmonary and Critical Care Medicine at Vanderbilt Health.

“Studies like RSI are critically important to understand the treatments that patients are already receiving and to ensure that patients receive the treatments that will result in the best outcomes,” he said.

Doctors treating seriously ill patients in an emergency setting may want to give the sedative etomidate, rather than ketamine, while placing a breathing tube, according to a randomized trial published in the New England Journal of Medicine.

The Randomized Trial of Sedative Choice for Intubation (RSI) is the first multicenter trial to demonstrate significant cardiovascular risks of high doses of ketamine (low blood pressure, arrhythmia), side effects that have not been well studied in the past.

Outlet: Mirage news story 

outlet: UAB press release 

Sedative choice could improve patient outcomes in patients who have been intubated.  

Etomidate proves more effective for sedative use in patient intubations

• Read this story and more at https://www.uab.edu/news/
• The UAB News Studio is available for live or taped interviews with UAB experts.

BIRMINGHAM, Ala. – Intubations are a common medical practice in which doctors insert a tube into the trachea to hold the airway open for patients who cannot breathe effectively due to illness or trauma-related injuries. Results in a recent multisite trial, in which the University of Alabama at Birmingham was a trial site, revealed doctors may want to consider utilizing etomidate, rather than ketamine, during intubation procedures.

Key takeaways:

• In the ketamine group, 28.1% died in the hospital by day 28 vs. 29.1% in the etomidate group.
• More patients assigned ketamine vs. etomidate had a greater than 30 mm Hg reduction in systolic blood pressure.

Perspective from Robert Glatter, MD, FACEP, FAAEM

In-hospital mortality by day 28 did not significantly differ based on use of ketamine or etomidate to induce anesthesia in critically ill adults undergoing intubation, according to results published in The New England Journal of Medicine.

outlet: Healthday News Story 

No reduction seen in in-hospital death by day 28 with use of ketamine rather than etomidate to induce anesthesia in critically ill adults undergoing tracheal intubation

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

outlet: HCMC press release 

Doctors treating seriously ill patients in an emergency setting may want to give the sedative etomidate, rather than ketamine, while placing a breathing tube, according to a randomized trial published Dec. 9 in the New England Journal of Medicine.

The Randomized Trial of Sedative Choice for Intubation (RSI) is the first multicenter trial to demonstrate significant cardiovascular risks of high doses of ketamine (low blood pressure, arrhythmia), side effects that have not been well studied in the past.

Outlet: Clinical Advisor 

In critically ill adults undergoing emergency tracheal intubation, etomidate did not increase the risk of in-hospital death and resulted in fewer episodes of cardiovascular collapse compared with ketamine, according to findings published in the New England Journal of Medicine. Cardiovascular collapse is a peri-procedural outcome defined as severe hypotension, new or increased vasopressors, cardiac arrest, or death. The occurrence of cardiovascular collapse during tracheal intubation of critically ill adults increases patients’ risk of in-hospital mortality.

 

outlet: Wake Forest press release 

It’s the first study to demonstrate cardiovascular risks of high doses of ketamine (low blood pressure, arrhythmia), side effects that have not been well studied in the past.Share:Share on FacebookShare on BskyShare on XShare on LinkedInShare via Email

Doctors treating seriously ill patients in an emergency setting may want to give the sedative etomidate, rather than ketamine, while placing a breathing tube, according to a randomized trial published Dec. 10 in the New England Journal of Medicine.

The Randomized Trial of Sedative Choice for Intubation (RSI) is the first multicenter trial to demonstrate significant cardiovascular risks of high doses of ketamine (low blood pressure, arrhythmia), side effects that have not been well studied in the past.

Outlet: VUMC Press Release

— Large randomized trial weighs survival and cardiovascular complications

outlet: Sedative Choice May Boost Breathing Tube Outcomes

Outlet: Respiratory Therapy News Story 

Results of a clinical trial comparing sedation of intubated patients using ketamine or etomidate found greater risks and fewer benefits when using ketamine.

Outlet: News Medical Life Sciences