Historical collection · First published Dec 9, 2025; added to EM Weekly Oct 27, 2026. This retrospective summary may be superseded by later evidence or guidance.
← All articlesKetamine or Etomidate for Tracheal Intubation of Critically Ill Adults
Summary
This multicenter trial assigned 2,365 critically ill adults undergoing intubation to ketamine or etomidate. In-hospital mortality by day 28 was similar, while cardiovascular collapse during intubation occurred more often with ketamine.
Why it matters
Do not assume ketamine protects hemodynamics or improves survival compared with etomidate during emergency intubation. Plan blood-pressure support whichever induction agent is chosen.
Study at a glance
- Design
- Randomized trial
- Population
- Critically ill adults undergoing intubation at 14 US ED/ICU sites.
- Sample size
- 2365
- Intervention
- Ketamine for induction of anesthesia.
- Comparator
- Etomidate for induction of anesthesia.
- Primary endpoint
- In-hospital all-cause death by day 28.
Main findings
- Mortality: 28.1% versus 29.1%; adjusted risk difference -0.8 percentage points (95% CI -4.5 to 2.9).
- Cardiovascular collapse: 22.1% versus 17.0%; risk difference 5.1 percentage points (95% CI 1.9 to 8.3).
Limitations
The trial was unblinded and included both ED and ICU patients. The mortality confidence interval includes clinically meaningful differences in either direction.
Read the primary source
Full text: Open-access full text available.
Original sourcePMID: 41369227
Material reviewed: abstract.
Source retrieved Oct 27, 2026. Publisher and PubMed indexed abstracts reviewed. Legal author manuscript is identified as PMC12711137, but its full text was not reviewed. Publisher confirms December 9 online date; April 2026 is the print issue. Direct journal/PubMed opens encountered access challenges.
Corrections & review history
No corrections recorded. Human review: not yet human-reviewed.