Comparison of Etomidate versus Ketamine for Rapid Sequence Intubation in Critically Ill Emergency Patients: A Retrospective Study

Abstract

Background: Rapid sequence intubation is a critical emergency procedure used to secure the airway in critically ill patients.

Objective: To compare the effectiveness and safety of etomidate versus ketamine for rapid sequence intubation in critically ill emergency patients.

Methodology: This retrospective comparative study was conducted at Allied Hospital Faisalabad from Sep 2025- Nov 2025. Medical records of 125 critically ill adult patients who underwent rapid sequence intubation were reviewed. Patients were divided into two groups: etomidate group (n=63) and ketamine group (n=62).

Results: First-pass intubation success was slightly higher in the etomidate group than the ketamine group (90.5% vs. 85.5%, p=0.390). Post-intubation hypotension (15.9% vs. 29.0%, p=0.078) and vasopressor requirement (19.0% vs. 32.3%, p=0.089) were lower in the etomidate group, although not statistically significant. Mean arterial pressure reduction was significantly lower with etomidate compared with ketamine (11.8 ± 7.4 vs. 15.6 ± 8.2 mmHg, p=0.008). ICU mortality (19.0% vs. 24.2%, p=0.480) and in-hospital mortality (23.8% vs. 29.0%, p=0.511) were comparable between groups.

Conclusion: Both etomidate and ketamine were effective induction agents for rapid sequence intubation in critically ill emergency patients. Etomidate demonstrated better peri-intubation hemodynamic stability, while first-pass success, complications, ICU stay, hospital stay, and mortality were comparable between the two groups.