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The following is a summary of “Effect of Ketamine Versus Etomidate for Rapid Sequence Intubation on Maximum Sequential Organ Failure Assessment Score: A Randomized Clinical Trial,” published in the November 2023  issue of Emergency Medicine by Knack et al.

Using induction drugs for rapid sequence intubation (RSI) has been linked to low blood pressure in people who are very sick. Most of the time, etomidate and ketamine are used as induction agents. The choice of agent may be important. For a study, researchers sought to find out how a single dose of ketamine or etomidate for RSI affected the highest Sequential Organ Failure Assessment (SOFA) score and the number of times people had low blood pressure. 

The single-center, randomized, parallel-group study looked at how ketamine and etomidate were used for RSI in seriously sick adult patients in the emergency room. Under Exception from Informed Consent, the study was done. The main result was the highest SOFA test within three days of leaving the hospital. 

The study had 143 patients; 70 were in the ketamine group, and 73 were in the etomidate group. There was no significant difference between the groups when looking at the maximum SOFA score. For the ketamine group, it was 6.5 (interquartile range [IQR] 5–9), and for the etomidate group, it was 7 (IQR 5–9).  About 28% of people in the ketamine group had low blood pressure after being tubed, but only 26% of people in the etomidate group did (a difference of 2%; 95% CI –13% to 17%). There were no big changes in how things turned out in the intensive care unit. The death rate after 30 days was the same for both groups: 11% (8 deaths) for the ketamine group and 21% (15 deaths) for the etomidate group. 

There were no big changes in the highest SOFA score or low blood pressure after intubation between people who were seriously ill and were given ketamine or etomidate for RSI.

Source: sciencedirect.com/science/article/abs/pii/S073646792300358X