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A multicenter investigation of the hemodynamic effects of induction agents for trauma rapid sequence intubation
Emily Leede1, James Kempema, Chad Wilson
1From the Department of Surgery and Perioperative Care (E.L., J.K., C.V.R.B., F.B.), Dell Medical School at the University of Texas at Austin, Austin; Division of Trauma and Acute Care Surgery 3 (C.W., A.K.), Ben Taub Hospital, Houston; Department of Surgery (A.J.R.T.), University Medical Center of El Paso, El Paso; Department of Surgery (A.C., L.A.), University of Texas Health Science Center at Tyler, Tyler; Department of Surgery (E.F., V.E.H.), University of Texas Health Science Center at Houston, Houston; Division of Acute Care Surgery (J.R.), Baylor Scott&White Medical Center-Temple, Temple; Department of Surgery (R.R., N.T.), University Medical Center, Lubbock; Department of Surgery (M.C.), Medical City Plano, Plano, Texas.
Background:
Several options exist for induction agents during rapid sequence intubation (RSI) in trauma patients, including etomidate, ketamine, and propofol. These drugs have reported variable hemodynamic effects (hypotension with propofol and sympathomimetic effects with ketamine) that could affect trauma resuscitations. The purpose of this study was to compare the hemodynamic effects of these three induction agents during emergency department RSI in adult trauma. We hypothesized that these drugs would display a differing hemodynamic profile during RSI.
Methods:
We performed a retrospective (2014-2019), multicenter trial of adult (≥18 years) trauma patients admitted to eight ACS-verified Level I trauma centers who underwent emergency department RSI. Variables collected included systolic blood pressure (SBP) and pulse before and after RSI. The primary outcomes were change in heart rate and SBP before and after RSI.
Results:
There were 2,092 patients who met criteria, 85% received etomidate (E), 8% ketamine (K), and 7% propofol (P). Before RSI, the ketamine group had a lower SBP (E, 135 vs. K, 125 vs. P, 135 mm Hg, p = 0.04) but there was no difference in pulse (E, 104 vs. K, 107 vs. P, 105 bpm, p = 0.45). After RSI, there were no differences in SBP (E, 135 vs. K, 130 vs. P, 133 mm Hg, p = 0.34) or pulse (E, 106 vs. K, 110 vs. P, 104 bpm, p = 0.08). There was no difference in the average change of SBP (E, 0.2 vs. K, 5.2 vs. P, -1.8 mm Hg, p = 0.4) or pulse (E, 1.7 vs. K, 3.5 bpm vs. P, -0.96, p = 0.24) during RSI.
Conclusion:
Contrary to our hypothesis, there was no difference in the hemodynamic effect for etomidate versus ketamine versus propofol during RSI in trauma patients.
Level Of Evidence:
Therapeutic, Level IV.
