Effectiveness and safety of ketamine and etomidate for rapid sequential intubation: a Meta-analysis

CHENG Shuping; HE Pei; LIU Yuanfei; WU Lidong

doi:10.7619/jcmp.20233344

Journal of Clinical Medicine in Practice > 2024 > 28(9): 82-89. > DOI: 10.7619/jcmp.20233344

CHENG Shuping, HE Pei, LIU Yuanfei, WU Lidong. Effectiveness and safety of ketamine and etomidate for rapid sequential intubation: a Meta-analysis[J]. Journal of Clinical Medicine in Practice, 2024, 28(9): 82-89. DOI: 10.7619/jcmp.20233344

Citation:

PDF (5257 KB)

Effectiveness and safety of ketamine and etomidate for rapid sequential intubation: a Meta-analysis

1.
Department of Emergency, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330200
2.
Department of Rehabilitation, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006

More Information

Received Date: October 20, 2023
Revised Date: December 05, 2023
Available Online: May 14, 2024

Graphical Abstract

Abstract

Abstract

Objective
To compare the effectiveness and safety of ketamine and etomidate for rapid sequential intubation.
Methods
Randomized controlled trials and cohort studies with ketamine and etomidate for RSI in patients with acute and critical illnesses published by China National Knowledge Infrastructure, Wanfang Data, VIP Network, PubMed, Embase, Cochrane Library and Clinicaltrials.gov from the date of database creation to May 1, 2023 were searched by computer. The literatures were screened according to inclusion and exclusion criteria, and the data of literatures were also extracted for quality assessment. Meta-analysis was performed by RevMan 5.3 software.
Results
A total of 15 literatures with 20 839 patients were included, including 3 RCT studies and 12 cohort studies. Meta-analysis showed that there were no significant differences in the success rate of primary intubation (RR=0.99, 95 %CI, 0.98 to 1.00, P=0.10), incidence of cardiac arrest (RR=1.00, 95 %CI, 0.62 to 1.62, P=0.99), time of mechanical ventilation (MD=0.33, 95 %CI, -0.34 to 1.01, P=0.33), and mortality rate (RR=1.05, 95 %CI, 0.95 to 1.16, P=0.31) between the ketamine group and the etomidate group, but the incidence of adrenal insufficiency (RR=0.54, 95 %CI, 0.41 to 0.70, P < 0.001) and ICU stay (MD=-0.44, 95 %CI, -0.70 to -0.18, P=0.001) in the etomidate group were significantly lower and shorter than those in the ketamine group, while the incidence of hypoxemia was significantly higher in the etomidate group (RR=1.50, 95 %CI, 1.27 to 1.79, P < 0.001).
Conclusion
During the process of RSI with sufficient preoxygenation, ketamine is a safe and effective alternative drug, and compared with etomidate, it has a lower incidence of adrenal insufficiency and shorter ICU stay.
- ketamine,
- etomidate,
- rapid sequential intubation,
- success rate of primary intubation,
- adrenocortical insufficiency,
- Meta-analysis

FullText(HTML)

References (30)

References

[1]	MOSIER J M, SAKLES J C, LAW J A, et al. Tracheal intubation in the critically ill. where we came from and where we should go[J]. Am J Respir Crit Care Med, 2020, 201(7): 775-788. doi: 10.1164/rccm.201908-1636CI
[2]	APRIL M D, LONG B, BROWN C A 3rd. Etomidate should be the default agent for rapid sequence intubation in the emergency department[J]. Ann Emerg Med, 2021, 78(6): 720-721. doi: 10.1016/j.annemergmed.2021.05.018
[3]	PEKSA G D, GOTTLIEB M. Ketamine should be the preferred agent for rapid sequence intubation[J]. Ann Emerg Med, 2021, 78(6): 722-723. doi: 10.1016/j.annemergmed.2021.07.118
[4]	ALBERT S G, ARIYAN S, RATHER A. The effect of etomidate on adrenal function in critical illness: a systematic review[J]. Intensive Care Med, 2011, 37(6): 901-910. doi: 10.1007/s00134-011-2160-1
[5]	MERELMAN A H, PERLMUTTER M C, STRAYER R J. Alternatives to rapid sequence intubation: contemporary airway management with ketamine[J]. West J Emerg Med, 2019, 20(3): 466-471. doi: 10.5811/westjem.2019.4.42753
[6]	PATANWALA A E, MCKINNEY C B, ERSTAD B L, et al. Retrospective analysis of etomidate versus ketamine for first-pass intubation success in an academic emergency department[J]. Acad Emerg Med, 2014, 21(1): 87-91. doi: 10.1111/acem.12292
[7]	PRICE B, ARTHUR A O, BRUNKO M, et al. Hemodynamic consequences of ketamine vs etomidate for endotracheal intubation in the air medical setting[J]. Am J Emerg Med, 2013, 31(7): 1124-1132. doi: 10.1016/j.ajem.2013.03.041
[8]	UPCHURCH C P, GRIJALVA C G, RUSS S, et al. Comparison of etomidate and ketamine for induction during rapid sequence intubation ofAdult trauma patients[J]. Ann Emerg Med, 2017, 69(1): 24-33, e2. doi: 10.1016/j.annemergmed.2016.08.009
[9]	WAN C, HANSON A C, SCHULTE P J, et al. Propofol, ketamine, and etomidate as induction agents for intubation and outcomes in critically ill patients: a retrospective cohort study[J]. Crit Care Explor, 2021, 3(5): e0435. doi: 10.1097/CCE.0000000000000435
[10]	MATCHETT G, GASANOVA I, RICCIO C A, et al. Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial[J]. Intensive Care Med, 2022, 48(1): 78-91. doi: 10.1007/s00134-021-06577-x
[11]	APRIL M D, ARANA A, SCHAUER S G, et al. Ketamine versus etomidate and peri-intubation hypotension: a national emergency airway registry study[J]. Acad Emerg Med, 2020, 27(11): 1106-1115. doi: 10.1111/acem.14063
[12]	STANKE L, NAKAJIMA S, ZIMMERMAN L H, et al. Hemodynamic effects of ketamine versus etomidate for prehospital rapid sequence intubation[J]. Air Med J, 2021, 40(5): 312-316. doi: 10.1016/j.amj.2021.05.009
[13]	VAN BERKEL M A, EXLINE M C, CAPE K M, et al. Increased incidence of clinical hypotension with etomidate compared to ketamine for intubation in septic patients: a propensity matched analysis[J]. J Crit Care, 2017, 38: 209-214. doi: 10.1016/j.jcrc.2016.11.009
[14]	FARRELL N M, KILLIUS K, KUE R, et al. A comparison of etomidate, ketamine, and methohexital in emergency department rapid sequence intubation[J]. J Emerg Med, 2020, 59(4): 508-514. doi: 10.1016/j.jemermed.2020.06.054
[15]	MOHR N M, PAPE S G, DAN R D, et al. Etomidate use is associated with less hypotension than ketamine for emergency department sepsis intubations: a NEAR cohort study[J]. Acad Emerg Med, 2020, 27(11): 1140-1149. doi: 10.1111/acem.14070
[16]	DRIVER B ER. Ketamine versus etomidate for rapid sequence intubation[EB/OL]. ClinicalTrials. gov. 2019. Available from: https://clinicaltrials.gov/ct2/show/study/NCT01823328.
[17]	POLLACK M A, FENATI G M, PENNINGTON T W, et al. The use of ketamine for air medical rapid sequence intubation was not associated with a decrease in hypotension or cardiopulmonary arrest[J]. Air Med J, 2020, 39(2): 111-115. doi: 10.1016/j.amj.2019.11.003
[18]	JABRE P, COMBES X, LAPOSTOLLE F, et al. Etomidate versus ketamine for rapid sequence intubation in acutely ill patients: a multicentre randomised controlled trial[J]. Lancet, 2009, 374(9686): 293-300. doi: 10.1016/S0140-6736(09)60949-1
[19]	SIVILOTTI M L, FILBIN M R, MURRAY H E, et al. Does the sedative agent facilitate emergency rapid sequence intubation[J]. Acad Emerg Med, 2003, 10(6): 612-620. doi: 10.1111/j.1553-2712.2003.tb00044.x
[20]	阚景祥, 朱海颖, 赵国芹, 等. 依托咪酯与氯胺酮对ICU脓毒症患者插管后血压的影响[J]. 中国急救医学, 2018, 38(2): 184-188. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJJY201802021.htm
[21]	ENGSTROM K, BROWN C S, MATTSON A E, et al. Pharmacotherapy optimization for rapid sequence intubation in the emergency department[J]. Am J Emerg Med, 2023, 70: 19-29. doi: 10.1016/j.ajem.2023.05.004
[22]	SHARDA S C, BHATIA M S. Etomidate compared to ketamine for induction during rapid sequence intubation: a systematic review and meta-analysis[J]. Indian J Crit Care Med, 2022, 26(1): 108-113. doi: 10.5005/jp-journals-10071-24086
[23]	NATT B S, MALO J, HYPES C D, et al. Strategies to improve first attempt success at intubation in critically ill patients[J]. Br J Anaesth, 2016, 117(Suppl 1): i60-i68.
[24]	GIL-JARDINÉ C, JABRE P, ADNET F, et al. Incidence and factors associated with out-of-hospital peri-intubation cardiac arrest: a secondary analysis of the CURASMUR trial[J]. Intern Emerg Med, 2022, 17(2): 611-617. doi: 10.1007/s11739-021-02903-9
[25]	APRIL M D, ARANA A, REYNOLDS J C, et al. Peri-intubation cardiac arrest in the Emergency Department: a National Emergency Airway Registry (NEAR) study[J]. Resuscitation, 2021, 162: 403-411. doi: 10.1016/j.resuscitation.2021.02.039
[26]	SMISCHNEY N J, KHANNA A K, BRAUER E, et al. Risk factors for and outcomes associated with peri-intubation hypoxemia: a multicenter prospective cohort study[J]. J Intensive Care Med, 2021, 36(12): 1466-1474. doi: 10.1177/0885066620962445
[27]	RUSSOTTO V, MYATRA S N, LAFFEY J G, et al. Intubation practices and adverse peri-intubation events in critically ill patients from 29 countries[J]. JAMA, 2021, 325(12): 1164-1172. doi: 10.1001/jama.2021.1727
[28]	VALK B I, STRUYS M M R F. Etomidate and its analogs: a review of pharmacokinetics and pharmacodynamics[J]. Clin Pharmacokinet, 2021, 60(10): 1253-1269. doi: 10.1007/s40262-021-01038-6
[29]	BRUDER E A, BALL I M, RIDI S, et al. Single induction dose of etomidate versus other induction agents for endotracheal intubation in critically ill patients[J]. Cochrane Database Syst Rev, 2015, 1(1): CD010225.
[30]	KUZA C M, TO J, CHANG A, et al. A retrospective data analysis on the induction medications used in trauma rapid sequence intubations and their effects on outcomes[J]. Eur J Trauma Emerg Surg, 2022, 48(3): 2275-2286. doi: 10.1007/s00068-021-01759-0

[1]	ZHANG Yang, DIAO Haiqing, Li Mengyue, TIAN Ting, LIU Xiaoguang, MA Qiang, LU Guangyu, YU Hailong, LI Yuping. Influencing factors of aspiration in neurological critically ill patients: a Meta-analysis[J]. Journal of Clinical Medicine in Practice, 2025, 29(1): 118-124. DOI: 10.7619/jcmp.20242193
[2]	QIN Qi, Alimujiang·YUSUFU, LIU Yuzhe, YIN Can, CUI Sha, RAN Jian. Efficacy of femoral neck system and cannulated screw in treatment of femoral neck fracture: a meta-analysis[J]. Journal of Clinical Medicine in Practice, 2024, 28(2): 63-72. DOI: 10.7619/jcmp.20231674
[3]	Alimujiang·YUSUFU, Azigu·YUSUFU, Abudula·ABULAITI, RAN Jian. Meta-analysis of the efficacy and safety of non-steroidal anti-inflammatory drugs in bone healing period[J]. Journal of Clinical Medicine in Practice, 2023, 27(21): 17-24. DOI: 10.7619/jcmp.20232256
[4]	LIU Ping, JIANG Xuelian, MA Jing, QIN Siyi, LIN Mujun. Meta-analysis of the intervention effect of olfactory disorders in patients with pituitary tumor after operation[J]. Journal of Clinical Medicine in Practice, 2023, 27(13): 32-36. DOI: 10.7619/jcmp.20230799
[5]	JIANG Haoyue, YU Shujun, TANG Yibo, SHEN Zhenru, LIU Zhejun, TANG Tian, WANG Shuaiqiang, TONG Kejin, LIU Zhenquan. Meta-analysis of efficacy of Shengjing Capsules (Tablets) in the treatment of oligoasthenospermia[J]. Journal of Clinical Medicine in Practice, 2022, 26(21): 46-54. DOI: 10.7619/jcmp.20222610
[6]	ZHU Yuting, CHEN Ying, WANG Xinxin, TIAN Miao, KONG Xiang, WANG Yan. Effect of high-intensity exercise during pregnancy on maternal and neonatal outcomes: A Meta-analysis[J]. Journal of Clinical Medicine in Practice, 2021, 25(6): 97-105. DOI: 10.7619/jcmp.20210051
[7]	ZHAO Yan, LI Li, DONG Xianhui, WANG Juyang. Effect of ketogenic diet in the treatment of patients with type 2 diabetes: a Meta-analysis[J]. Journal of Clinical Medicine in Practice, 2020, 24(18): 87-97. DOI: 10.7619/jcmp.202018025
[8]	QU Tao, ZHANG Honggang, CUI Chengxu, YANG Lin. Correlation between CYP2A6 polymorphisms and clinical outcome of S-1-based chemotherapy in patients with advanced cancer: A meta-analysis[J]. Journal of Clinical Medicine in Practice, 2015, (3): 15-19. DOI: 10.7619/jcmp.201503004
[9]	ZHOU Qingyun, WEI Zhongqing, CHEN Xinmei. Meta-analysis of evidence-based nursing of patients with transurethral resection of prostate[J]. Journal of Clinical Medicine in Practice, 2014, (22): 71-74. DOI: 10.7619/jcmp.201422022
[10]	WANG Zihui, HAN Feifei, LIU Lihong. A meta-analysis of relationship between acid-suppressive drugs ingested by pregnant women and their descendent asthma[J]. Journal of Clinical Medicine in Practice, 2014, (19): 88-90. DOI: 10.7619/jcmp.201419026

Cited By

Cited by

Periodical cited type(21)

1.	张建，李晓琦，蒋芳琴，潘爱芬，张怀永. 基于行为改变轮理论的早期康复干预对下肢骨折术后病人的影响. 循证护理. 2024(11): 2046-2051 .
2.	刘蓉，贾晓雯. 快速康复外科护理对下肢骨折患者的影响. 检验医学与临床. 2020(01): 107-110 .
3.	陈倩，柴宇霞，裴理辉，尹慧珍. 预防跌倒细节护理在神经外科老年患者护理中的应用价值. 河南医学研究. 2020(04): 718-720 .
4.	王璐璐，李乐，韦帅. 术后强化护理干预对下肢骨折老年患者便秘及下肢静脉血栓发生率的影响. 实用医技杂志. 2020(04): 523-524 .
5.	朱艳英. 细节护理在下肢骨折患者术后跌倒预防中的应用有效性分析. 中国农村卫生. 2020(10): 73 .
6.	林锦芝. 精细化护理对下肢骨折患者的效果分析. 四川医学. 2020(05): 544-548 .
7.	刘志蓉. 预防跌倒细节护理对老年患者发生意外骨折的临床影响分析. 人人健康. 2020(14): 362 .
8.	李薇. 护理风险管理对骨折患者跌倒的预防效果观察. 基层医学论坛. 2020(27): 3994-3995 .
9.	谢贤兰，洪晓燕. 循证护理对下肢骨折术后静脉血栓形成的控制作用. 饮食科学. 2019(10): 61 .
10.	蒲德美，郭慧莹. 细节护理在肝炎患者护理中的应用价值分析. 智慧健康. 2019(19): 94-95 .
11.	陈燕. 基于健康理念模式的细节行为护理在预防乳腺癌患者腋窝淋巴结清扫手术术后淋巴水肿中的临床应用. 中国全科医学. 2019(S1): 219-222 .
12.	李标. 早期运动康复对下肢骨折骨密度、关节活动度及并发症的影响. 实用中西医结合临床. 2019(08): 20-22 .
13.	李松鞠，王慧慧. 预防性护理干预在下肢骨折术后护理中的应用疗效观察. 全科口腔医学电子杂志. 2019(32): 109-110 .
14.	甘彩芳. 细节护理对肿瘤内科老年患者发生意外骨折的影响分析. 临床医药文献电子杂志. 2019(91): 100 .
15.	郭元元. 老年下肢骨折患者护理中实施综合护理的实效性评价. 双足与保健. 2018(11): 156-157 .
16.	黄悦. 优质护理对下肢骨折患者术后膝关节僵硬发生率的影响分析. 世界最新医学信息文摘. 2018(50): 24-25 .
17.	孔卫玲. 内固定手术的下肢骨折患者实施细节化手术配合护理的效果分析. 辽宁医学杂志. 2018(05): 39-41 .
18.	钟燕萍. 细节护理在桡骨头骨折内固定手术护理中的应用分析. 中国现代药物应用. 2018(23): 185-186 .
19.	任奇，郭秀英. 观察预防跌倒细节护理对老年患者发生意外骨折的影响. 中国医药科学. 2017(23): 95-97 .
20.	司春华. 急救路径护理对创伤性下肢骨折患者负性情绪及并发症的影响. 双足与保健. 2017(13): 20-21 .
21.	袁春艳. 术后强化护理对下肢骨折患者术后并发症及生活质量的影响. 双足与保健. 2017(23): 116+118 .

Other cited types(1)

Get Citation

PDF

XML

Article views (124) PDF downloads (8) Cited by(22)

Turn off MathJax

Article Contents

Abstract

References

Effectiveness and safety of ketamine and etomidate for rapid sequential intubation: a Meta-analysis