Mapping haemodynamic changes with rapid sequence induction agents in the emergency department.

Area of Science:

• Emergency Medicine
• Anesthesiology
• Critical Care

Background:

• Patients undergoing endotracheal intubation in the emergency department (ED) face a significant risk of post-intubation hypotension.
• Limited evidence exists to guide the selection of the optimal induction agent for rapid sequence induction (RSI) in the ED.

Purpose of the Study:

• To compare the hemodynamic effects of propofol, ketamine, and thiopental during RSI in the ED.
• To identify associations between induction agents, dosage, and the incidence of post-intubation hypotension.

Main Methods:

• Observational study utilizing data from the Australian and New Zealand Emergency Department Airway Registry (June 2012 - March 2019).
• Analysis of 2229 intubation episodes, comparing hemodynamic stability (systolic blood pressure changes) across induction agents.
• Multivariable logistic regression used to assess the relationship between induction agent, dose, and hypotension.

Main Results:

• Propofol and ketamine were independently associated with post-intubation hypotension (P=0.01).
• Both agents demonstrated a dose-dependent relationship with hypotension.
• A higher proportion of ketamine-induced patients exhibited a shock index exceeding 0.9, suggesting potential hemodynamic compromise.

Conclusions:

• Propofol use is associated with an increased risk of post-intubation hypotension; lowest effective doses are recommended.
• While ketamine may be perceived as hemodynamically stable, its use is also linked to post-intubation hypotension.
• Further research is needed to optimize induction agent selection for hemodynamic stability during ED intubation.