Retrospective analysis of etomidate versus ketamine for first-pass intubation success in an academic emergency department

Objectives The objective of this study was to compare first-pass intubation success between patients who received etomidate versus ketamine for rapid sequence intubation (RSI) in the emergency department (ED). Methods This was a retrospective analysis of prospectively collected data recorded in a quality improvement database between July 1, 2007, and December 31, 2012. The study was conducted in an academic ED in the United States. All patients who received etomidate or ketamine as part of RSI were included. The primary outcome measure was first-pass success. A multivariate analysis was conducted to determine if sedative type was associated with first-pass success, after adjusting for potential confounders and baseline differences. Results The final cohort consisted of 2,098 RSI procedures using either etomidate (n = 1,983) or ketamine (n = 115). First-pass success occurred in 77.0% of patients in the etomidate group and 79.1% of patients in the ketamine group (difference = -2.1%; 95% CI = -5.5% to 9.8%). In the multivariate analysis, after adjusting for potential confounders, sedative type was not associated with first-pass success (odds ratio = 0.89; 95% CI = 0.5 to 1.5; p = 0.632). Conclusions Etomidate and ketamine are associated with equivalent first-pass success when used in RSI. Ketamine may be an appropriate alternative to etomidate for RSI in the ED.