Ketamine, Etomidate, and Mortality in Emergency Department Intubations
Authors' conclusion
In this cohort study of critically ill adults undergoing RSI, etomidate use was associated with higher in-hospital mortality at 7 and 28 days compared with ketamine.
Study context
- Population
- Critically ill adults undergoing rapid sequence intubation (RSI) in 18 Brazilian EDs (Brazilian Airway Registry Cooperation), March 2022–April 2024; preintubation cardiac arrest or immediate postintubation transfer excluded
- Participants
- 1,810 adults
- Exposure
- Etomidate vs ketamine as sole induction agent for RSI
- Etomidaten = 1,296
- Ketaminen = 514reference
- Outcome
- 28-day in-hospital mortality
- Follow-up
- 28 days
Methodological detailstarget trial emulation, observational registry data, inverse probability of treatment weighting, multicentre (18 EDs)
- Target trial emulation
- Observational registry data
- Inverse probability of treatment weighting
- Multicentre (18 EDs)
Main finding
As reported in the abstract
28-day in-hospital mortality (weighted)
Each group vs ketamineRelative risk (95% CI)
Etomidate
1.14(1.03–1.27)
Each group vs ketamineRD (95% CI)
Etomidate
7.6%(2.0%–13.3%)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | Etomidate | Ketamine | RR (95% CI) | |
|---|---|---|---|---|
| 7-day in-hospital mortality (weighted) | 35.2% (95% CI 32.0%–38.3%) | 30.1% (95% CI 23.5%–36.7%) | 1.19 (1.04–1.35) | |
| 0.512Relative risk (log scale) |
First-attempt intubation success
- No statistically significant difference
Safety
| Outcome | Etomidate | Ketamine | RR (95% CI) | |
|---|---|---|---|---|
| New hemodynamic instability within 30 min after intubation · 30 minutesMore frequent with ketamine | 18.9% (95% CI 16.7%–21.0%) | 24.2% (95% CI 20.4%–28.0%) | 0.78 (0.64–0.95) | |
| 0.512Relative risk (log scale) |
Severe hypoxemia and cardiac arrest within 30 min after intubation · 30 minutes
- No statistically significant differences
Original publication
Ketamine, Etomidate, and Mortality in Emergency Department Intubations. JAMA Netw Open. Published 1 December 2025. doi:10.
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