Ketamine Versus Etomidate for Rapid Sequence Intubation in Critically Ill Adults: A Comprehensive Systematic Review...

Area of Science:

• Critical care medicine
• Anesthesiology
• Pharmacology

Background:

• Emergency endotracheal intubation in critically ill patients necessitates rapid induction agents with minimal hemodynamic compromise.
• Etomidate is traditionally favored for its cardiovascular stability, while ketamine is increasingly used for its sympathomimetic effects.
• Comparative data on survival and meaningful outcomes between ketamine and etomidate for intubation are inconsistent.

Purpose of the Study:

• To systematically review and meta-analyze comparative data on ketamine versus etomidate for emergency intubation in critically ill adults.
• To compare the effectiveness and safety of these two induction agents regarding survival and procedural success.

Main Methods:

• A systematic review and meta-analysis of randomized and observational studies comparing ketamine and etomidate for emergency intubation.
• Searched major databases from inception to the most recent available date.
• Primary outcome: 30-day survival; Secondary outcomes: first-pass intubation success, post-intubation hypotension, SOFA score, vasopressor-free days, ventilator-free days.

Main Results:

• No significant difference in 30-day survival (OR: 1.0) or first-pass intubation success (OR: 0.95) between ketamine and etomidate.
• Ketamine was associated with a significantly higher risk of post-intubation hypotension (OR: 1.32) compared to etomidate.
• No significant differences were observed in SOFA scores, vasopressor-free days, or ventilator-free days.

Conclusions:

• Ketamine and etomidate demonstrate comparable short-term survival and procedural success in critically ill adults undergoing emergency intubation.
• Ketamine use is linked to an increased risk of post-intubation hypotension.
• Individualized selection of induction agents based on patient hemodynamics and clinical context is recommended.