Resuscitationists have debated the choice of induction agents in rapid sequence intubation (RSI) for decades. Critics of etomidate will highlight its link to adrenal suppression in critically ill patients (Albert 2011), while critics of ketamine will highlight the higher incidence of post-intubation hypotension (Mohr 2020). Amidst the debate, the Ketased Trial (Jabre 2009), a large multicenter prospective, single-blind randomized clinical trial (RCT), reported no significant difference in SOFA scores or 28-day mortality between the two induction agents. However, the EvK trial (Matchett 2022) identified a statistically significant difference in 7-day mortality but not 28-day mortality in favor of ketamine. However, methodological concerns from the EvK Trial warrant a cautious interpretation of the data. In light of these and several other recent high-quality clinical trials comparing ketamine and etomidate, this meta-analysis aims to provide a point estimate of the mortality rate.

https://rebelem.com/from-debate-to-data-emerging-insights-into-rsi-induction-with-ketamine-vs-etomidate/