Ketamine Versus Etomidate for Rapid Sequence Intubation: A Systematic Review and Meta-Analysis of Randomized Trials
Authors' conclusion
Compared with etomidate, ketamine probably results in more hemodynamic instability during the peri-intubation period and appears to have no effect on successful intubation on the first attempt or mortality. However, ketamine results in decreased need for the initiation of vasopressor use and decreases adrenal suppression compared with etomidate.
Study context
- Population
- Adults undergoing emergent endotracheal intubation
- Participants
- 2,384 adults · 7 randomized controlled trials (RCTs)
- Comparison
- Ketamine vs Etomidate
Methodological detailsrandom-effects model, GRADE certainty assessment, pre-registered protocol
- Random-effects model
- GRADE certainty assessment
- Pre-registered protocol
Further pooled results
| Outcome | Estimate | |
|---|---|---|
| Initiation of continuous infusion vasopressorsModerate certainty | RR for initiation of continuous infusion vasopressors 0.75 (95% CI 0.57–1.00) | |
| Adrenal suppressionModerate certainty | RR for adrenal suppression 0.54 (95% CI 0.45–0.66) | |
| Successful intubation on first attemptModerate certainty | RR for successful intubation on first attempt 1.01 (95% CI 0.97–1.05) | |
| MortalityLow certainty | RR for death 1.00 (95% CI 0.83–1.21) | |
| 0.512Ratio (log scale) |
| Outcome | Mean difference (SOFA points) (95% CI) |
|---|---|
| Organ dysfunction (maximum SOFA score, first 3 days in ICU)Moderate certainty | 0.55 lower (1.12 lower to 0.03 higher) |
Safety
| Outcome | RR (95% CI) | |
|---|---|---|
| Peri-intubation hemodynamic instability · peri-intubation periodModerate certainty | 1.29 (1.07–1.57) | |
| Initiation of continuous infusion vasopressorsModerate certainty | 0.75 (0.57–1.00) | |
| Adrenal suppressionModerate certainty | 0.54 (0.45–0.66) | |
| 0.512Relative risk (log scale) |
Original publication
Ketamine Versus Etomidate for Rapid Sequence Intubation: A Systematic Review and Meta-Analysis of Randomized Trials. Crit Care Med. Published 21 November 2024. doi:10.
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