Hemodynamics in Helicopter Emergency Medical Services (HEMS) Patients Undergoing Rapid Sequence Intubation With Etomidate or Ketamine

  • Scott Kunkel
    Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin

    Flight For Life, Waukesha, Wisconsin
    Search for articles by this author
  • Timothy Lenz
    Reprint Address: Timothy Lenz, MD, Department of Emergency Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, HUB 3rd Floor, Milwaukee, WI 53226
    Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin

    Flight For Life, Waukesha, Wisconsin
    Search for articles by this author



      Rapid sequence intubation (RSI) is performed by helicopter emergency medical services (HEMS) providers to establish airway control. Common induction agents are etomidate and ketamine, both touted to have relatively stable hemodynamic profiles. Limited data comparing these medications in the air medical setting exist.


      Compare administration of ketamine and etomidate on peri-intubation hemodynamics.


      A retrospective chart review of intubations performed by a HEMS program over 69 months was completed. Heart rate (HR) change, systolic blood pressure (SBP) change, and hypotension with etomidate or ketamine use were measured.


      There were 258 patients induced with etomidate and 48 with ketamine. Etomidate patients showed a +1.161% change in HR (SD ± 22.7) and −0.49% change in SBP (SD ± 25.0). Ketamine patients showed a −4.7% change in HR (SD ± 16.7) and 17.2% change in SBP (SD ± 43.4). The p-values for percentage change in HR and SBP between etomidate and ketamine were 0.0830 and 0.0018, respectively. Twenty-five episodes of postadministration hypotension occurred with etomidate, and two with ketamine (p = 0.028).


      Both ketamine and etomidate are appropriate for intubation of HEMS patients. Ketamine was preferentially selected for hypotensive patients with statistically significant improvement in SBP. Although statistically significant, both ketamine and etomidate had relative low incidences of hypotension.


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