Induction agents for emergency tracheal intubation in critically ill adults: a systematic review and network meta-analysis
Authors' conclusion
Etomidate and ketamine probably result in similar mortality, but confidence intervals are compatible with clinically important differences in either direction-ketamine probably causes more peri-intubation hemodynamic instability.
Study context
- Population
- Critically ill adults undergoing emergency or rapid sequence intubation
- Participants
- 4,672 adults · 9 RCTs
- Comparison
- Etomidate vs ketamine vs propofol vs ketofol as induction agents
- Outcome
- Short-term mortality (28-30 day, or ICU/in-hospital mortality when unavailable)
Methodological detailsrandom-effects, frequentist framework, CINeMA certainty assessment
- Random-effects
- Frequentist framework
- CINeMA certainty assessment
Pooled result
As reported in the abstract
Odds ratio (95% CI)
Ketamine vs Etomidateheterogeneity 30%; moderate certainty
0.96(0.80–1.16)
Ketamine vs Propofol1 trial; low certainty
1.53(0.80–2.93)
Etomidate vs Propofolindirect only; very low certainty
0.63(0.32–1.24)
Further pooled results
| Outcome | OR (CI) | |
|---|---|---|
| Post-induction hypotensionKetamine vs Etomidate · low certainty | 1.34 (1.07–1.68) | |
| Peri-intubation vasopressor useKetamine vs Etomidate · low certainty | 1.45 (1.21–1.74) | |
| 0.512Odds ratio (log scale) |
First-pass intubation success
- Probably little or no difference
Safety
| Outcome | OR (CI) | |
|---|---|---|
| Cardiovascular collapseKetamine vs Etomidate · moderate certainty | 1.44 (1.20–1.71) | |
| 0.512Odds ratio (log scale) |
Peri-intubation cardiac arrest
- Probably little or no difference
Original publication
Induction agents for emergency tracheal intubation in critically ill adults: a systematic review and network meta-analysis. Crit Care. Published 12 May 2026. doi:10.
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