Single-dose etomidate for intubation in the trauma patient

Area of Science:

• Emergency Medicine
• Critical Care
• Pharmacology

Background:

• Concerns regarding etomidate's potential for adrenal suppression led to restricted use in trauma patients.
• Adrenal suppression concerns prompted a policy change in etomidate administration for trauma patients in 2006.

Purpose of the Study:

• To compare mortality, hypotension, and length of stay (LOS) in trauma patients requiring intubation.
• To evaluate outcomes associated with liberal versus limited etomidate use in trauma resuscitation.

Main Methods:

• Retrospective review of 1325 trauma patients requiring emergent intubation (August 2004 - December 2008).
• Comparison of outcomes between periods of liberal (pre-July 2006) and limited (post-July 2006) etomidate use.
• Data collected included demographics, induction agents, hypotension episodes, ICU and hospital LOS, and survival.

Main Results:

• Etomidate use decreased significantly from 58% to 23% after policy change (p<0.0001).
• No significant differences in mortality (30% vs. 29%), ICU LOS (8.2 vs. 8.8 days), or hospital LOS (13.8 vs. 14.4 days) were observed.
• Hypotension episodes increased in the limited etomidate group (45% vs. 33%, p<0.0001).

Conclusions:

• Reduced etomidate use in trauma intubation was not linked to changes in mortality or length of stay.
• Limiting etomidate was associated with a higher incidence of hypotension within 24 hours post-intubation.
• Findings suggest a trade-off between etomidate's perceived safety and hemodynamic stability in trauma patients.