Abstract
Background
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.
Objective
Compare administration of ketamine and etomidate on peri-intubation hemodynamics.
Methods
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.
Results
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).
Conclusion
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.
Keywords
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Article info
Publication history
Published online: January 12, 2022
Accepted:
October 12,
2021
Received in revised form:
September 21,
2021
Received:
January 22,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
