Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea.
Gyeonggi Southern Regional Trauma Centre, Ajou University Hospital, Suwon, Republic of Korea.
BMC Emerg Med. 2023 May 29;23(1):57. doi: 10.1186/s12873-023-00833-7.
Ketamine and etomidate are commonly used as sedatives in rapid sequence intubation (RSI). However, there is no consensus on which agent should be favored when treating patients with trauma. This study aimed to compare the effects of ketamine and etomidate on first-pass success and outcomes of patients with trauma after RSI-facilitated emergency intubation.
We retrospectively reviewed 944 patients who underwent endotracheal intubation in a trauma bay at a Korean level 1 trauma center between January 2019 and December 2021. Outcomes were compared between the ketamine and etomidate groups after propensity score matching to balance the overall distribution between the two groups.
In total, 620 patients were included in the analysis, of which 118 (19.9%) were administered ketamine and the remaining 502 (80.1%) were treated with etomidate. Patients in the ketamine group showed a significantly faster initial heart rate (105.0 ± 25.7 vs. 97.7 ± 23.6, p = 0.003), were more hypotensive (114.2 ± 32.8 mmHg vs. 139.3 ± 34.4 mmHg, p < 0.001), and had higher Glasgow Coma Scale (9.1 ± 4.0 vs. 8.2 ± 4.0, p = 0.031) and Injury Severity Score (32.5 ± 16.3 vs. 27.0 ± 13.3, p < 0.001) than those in the etomidate group. There were no significant differences in the first-pass success rate (90.7% vs. 90.1%, p > 0.999), final mortality (16.1% vs. 20.6, p = 0.348), length of stay in the intensive care unit (days) (8 [4, 15] (Interquartile range)), vs. 10 [4, 21], p = 0.998), ventilator days (4 [2, 10] vs. 5 [2, 13], p = 0.735), and hospital stay (days) (24.5 [10.25, 38.5] vs. 22 [8, 40], p = 0.322) in the 1:3 propensity score matching analysis.
In this retrospective study of trauma resuscitation, those receiving intubation with ketamine had greater hemodynamic instability than those receiving etomidate. However, there was no significant difference in clinical outcomes between patients sedated with ketamine and those treated with etomidate.
氯胺酮和依托咪酯常被用作快速序贯插管（RSI）中的镇静剂。然而，在治疗创伤患者时，哪种药物更有优势尚无共识。本研究旨在比较氯胺酮和依托咪酯对 RSI 辅助急诊插管后创伤患者首次插管成功率和结局的影响。
我们回顾性分析了 2019 年 1 月至 2021 年 12 月期间在韩国一级创伤中心创伤室进行气管插管的 944 例患者。通过倾向评分匹配平衡两组的总体分布，比较了两组患者的结局。
共纳入 620 例患者，其中 118 例（19.9%）接受氯胺酮治疗，其余 502 例（80.1%）接受依托咪酯治疗。与依托咪酯组相比，氯胺酮组患者的初始心率更快（105.0 ± 25.7 次/分 vs. 97.7 ± 23.6 次/分，p = 0.003），血压更低（114.2 ± 32.8 mmHg vs. 139.3 ± 34.4 mmHg，p < 0.001），格拉斯哥昏迷评分（9.1 ± 4.0 分 vs. 8.2 ± 4.0 分，p = 0.031）和损伤严重程度评分（32.5 ± 16.3 分 vs. 27.0 ± 13.3 分，p < 0.001）更高。首次插管成功率（90.7% vs. 90.1%，p > 0.999）、最终死亡率（16.1% vs. 20.6%，p = 0.348）、入住重症监护病房时间（天）（8 [4，15]（四分位距） vs. 10 [4，21]，p = 0.998）、呼吸机使用时间（天）（4 [2，10] vs. 5 [2，13]，p = 0.735）和住院时间（天）（24.5 [10.25，38.5] vs. 22 [8，40]，p = 0.322）在 1:3 倾向评分匹配分析中无显著差异。
在这项关于创伤复苏的回顾性研究中，接受氯胺酮插管的患者比接受依托咪酯插管的患者血流动力学更不稳定。然而，接受氯胺酮镇静和依托咪酯治疗的患者在临床结局方面无显著差异。
