Affiliation:
1. Ajou University School of Medicine
2. Ajou University Hospital
Abstract
Abstract
Background
Ketamine and etomidate are commonly used as sedatives in rapid sequence intubation (RSI). However, there is no consensus on which agent should be favoured when treating patients with trauma. This study aimed to compare the effects of ketamine and etomidate on first-pass success and mortality in patients with trauma after RSI-facilitated emergency intubation.
Methods
We retrospectively reviewed 944 patients who underwent endotracheal intubation in a trauma bay at a Korean level 1 trauma centre between January 2019 and December 2021. Outcomes were compared between the ketamine and etomidate groups after propensity score matching to balance the overall distribution between the two groups.
Results
In total, 620 patients were included in the analysis, of which 118 (19.9%) were administered ketamine and the remaining 502 (80.1%) were treated with etomidate. Patients in the ketamine group showed a significantly faster initial heart rate (105.0 ± 25.7 vs. 97.7 ± 23.6, p = 0.003), more hypotensive (114.2 ± 32.8 mmHg vs. 139.3 ± 34.4 mmHg, p < 0.001), higher GCS (9.1 ± 4.0 vs. 8.2 ±4.0, P=0.031), and higher Injury Severity Score (32.5 ± 16.3 vs. 27.0 ± 13.3, p < 0.001) than those in the etomidate group. There were no significant differences in the first-pass success rate (90.7% vs. 90.1%, p > 0.999), mortality (16.1% vs. 20.6, p=0.348), ICU LOS (14.8 ± 31.9 vs. 14.8 ± 15.5, p = 0.998), ventilator days (9.0 ± 17.9 vs. 9.6 ± 12.2, p = 0.735), or hospital stay (31.0 ± 38.6 vs. 27.3 ± 22.9, p=0.322) in the 1:3 propensity score matching analysis.
Conclusion
During trauma resuscitation, ketamine was found to be the preferred sedative for patients who were hemodynamically unstable and conscious. However, there was no significant difference in clinical outcomes between patients sedated with ketamine and those treated with etomidate.
Publisher
Research Square Platform LLC
Reference22 articles.
1. Emergency tracheal intubation immediately following traumatic injury: an Eastern Association for the Surgery of Trauma practice management guideline;Mayglothling J;J Trauma Acute Care Surg,2012
2. Surrey & Sussex Air Ambulance Trust. Significant modification of traditional rapid sequence induction improves safety and effectiveness of pre-hospital trauma anaesthesia;Lyon RM;Crit Care,2015
3. Brown CA 3rd, Bair AE, Pallin DJ, Walls RM, NEAR III. Investigators. Techniques, success, and adverse events of emergency department adult intubations.Ann Emerg Med. 2015;65:363 – 70.e1.
4. Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial;Matchett G;Intensive Care Med,2022
5. Current practices and safety of medication use during rapid sequence intubation;Groth CM;J Crit Care,2018