Etomidate Compared to Ketamine for Induction during Rapid Sequence Intubation: A Systematic Review and Meta-analysis

Area of Science:

• Emergency Medicine
• Anesthesiology
• Critical Care

Background:

• Rapid sequence intubation (RSI) is a critical procedure for securing the airway in acutely ill patients.
• Choosing the appropriate induction agent is crucial for patient safety, balancing efficacy with the risk of adverse events.
• Etomidate and ketamine are commonly used induction agents, each with distinct hemodynamic profiles.

Purpose of the Study:

• To systematically review and meta-analyze the safety and efficacy of etomidate versus ketamine for RSI.
• To compare the incidence of post-induction hypotension and first-pass intubation success between etomidate and ketamine.
• To evaluate these outcomes in emergency department and prehospital settings.

Main Methods:

• Systematic review and meta-analysis of studies comparing etomidate and ketamine for RSI.
• Searched major databases (PubMed, Embase, Cochrane, ClinicalTrials.gov) up to June 1, 2021.
• Analyzed dichotomous outcomes (hypotension, intubation success) using random-effects meta-analysis to calculate odds ratios (OR) and 95% confidence intervals (CI).

Main Results:

• Nine eligible studies involving over 12,000 patients were included.
• Etomidate was associated with a significantly decreased risk of post-induction hypotension compared to ketamine (OR: 0.53; 95% CI: 0.31-0.91).
• No significant difference was observed in first-pass intubation success rates between etomidate and ketamine (OR: 1.13; 95% CI: 0.95-1.36).

Conclusions:

• Etomidate is a safer induction agent than ketamine regarding post-induction hypotension during RSI.
• The choice between etomidate and ketamine does not appear to affect the likelihood of successful first-pass intubation.
• Findings support the use of etomidate to mitigate hemodynamic instability in patients undergoing RSI.