Ketamine versus Etomidate for Rapid Sequence Intubation in Patients with Trauma: A Retrospective Study in a Level 1 Trauma center in Korea

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.