• Gerald Matchett, Irina Gasanova, Christina A Riccio, Dawood Nasir, Mary C Sunna, Brian J Bravenec, Omaira Azizad, Brian Farrell, Abu Minhajuddin, Jesse W Stewart, Lawrence W Liang, Tiffany Sun Moon, Pamela E Fox, Callie G Ebeling, Miakka N Smith, Devin Trousdale, Babatunde O Ogunnaike, and EvK Clinical Trial Collaborators.
• Department of Anesthesiology and Pain Management, UT-Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA. gerald.matchett@utsouthwestern.edu.
• Intensive Care Med. 2022 Jan 1; 48 (1): 789178-91.

PurposeEtomidate and ketamine are hemodynamically stable induction agents often used to sedate critically ill patients during emergency endotracheal intubation. In 2015, quality improvement data from our hospital suggested a survival benefit at Day 7 from avoidance of etomidate in critically ill patients during emergency intubation. In this clinical trial, we hypothesized that randomization to ketamine instead of etomidate would be associated with Day 7 survival after emergency endotracheal intubation.MethodsA prospective, randomized, open-label, parallel assignment, single-center clinical trial performed by an anesthesiology-based Airway Team under emergent circumstances at one high-volume medical center in the United States. 801 critically ill patients requiring emergency intubation were randomly assigned 1:1 by computer-generated, pre-randomized sealed envelopes to receive etomidate (0.2-0.3 mg/kg, n = 400) or ketamine (1-2 mg/kg, n = 401) for sedation prior to intubation. The pre-specified primary endpoint of the trial was Day 7 survival. Secondary endpoints included Day 28 survival.ResultsOf the 801 enrolled patients, 396 were analyzed in the etomidate arm, and 395 in the ketamine arm. Day 7 survival was significantly lower in the etomidate arm than in the ketamine arm (77.3% versus 85.1%, difference - 7.8, 95% confidence interval - 13, - 2.4, p = 0.005). Day 28 survival rates for the two groups were not significantly different (etomidate 64.1%, ketamine 66.8%, difference - 2.7, 95% confidence interval - 9.3, 3.9, p = 0.294).ConclusionWhile the primary outcome of Day 7 survival was greater in patients randomized to ketamine, there was no significant difference in survival by Day 28.© 2021. Springer-Verlag GmbH Germany, part of Springer Nature.

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