{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T21:59:58Z","timestamp":1789682398344,"version":"4.0.1"},"reference-count":31,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi251294-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>The choice of induction agent during rapid sequence intubation (RSI) of critically ill adults may affect clinical outcomes. Although ketamine and etomidate are frequently used for RSI, their comparative effectiveness remains controversial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi251294-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare the safety of etomidate vs ketamine for emergency RSI in critically ill adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi251294-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This cohort study used a target trial emulation with observational data collected between March 1, 2022, and April 30, 2024, from 18 emergency departments across Brazil, with data from the Brazilian Airway Registry Cooperation. Adults who underwent RSI and received either etomidate or ketamine as a sole hypnotic agent were included; those with preintubation cardiac arrest or immediate postintubation transfer were excluded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi251294-7\">\n                    <jats:title>Exposure<\/jats:title>\n                    <jats:p>Administration of etomidate or ketamine as the induction agent for RSI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi251294-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>The primary outcome was 28-day in-hospital mortality. Secondary outcomes included 7-day in-hospital mortality, first-attempt intubation success, and major adverse events (new hemodynamic instability, severe hypoxemia, and cardiac arrest) within 30 minutes after intubation. Inverse probability of treatment weighting was used to adjust for confounding. Risk ratios (RRs) and risk differences (RDs) with 95% CIs were used to compare outcomes between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi251294-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 1810 patients (median age, 64 years [IQR, 50-74 years]; 1048 men [57.9%]), 514 received ketamine and 1296 received etomidate. The median shock index was higher in the ketamine group than the etomidate group (0.81 [IQR, 0.65-1.01] vs 0.76 [IQR, 0.59-0.99]), and preintubation vasopressor use was more common in the ketamine group than the etomidate group (191 of 514 [37.2%] vs 391 of 1296 [30.2%]). Weighted 28-day mortality was higher with etomidate than ketamine (60.5% [95% CI, 57.2%-63.8%] vs 54.4% [95% CI, 45.0%-63.9%]; RR, 1.14 [95% CI, 1.03-1.27]; RD, 7.6% [95% CI, 2.0%-13.3%]). Seven-day mortality was also higher with etomidate than ketamine (35.2% [95% CI, 32.0%-38.3%] vs 30.1% [95% CI, 23.5%-36.7%]; RR, 1.19 [95% CI, 1.04-1.35]). New hemodynamic instability within 30 minutes after intubation was more frequent with ketamine (24.2% [95% CI, 20.4%-28.0%] vs 18.9% [95% CI, 16.7%-21.0%]; RR, 0.78 [0.64-0.95]). There were no statistically significant differences in the other secondary outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi251294-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>In this cohort study of critically ill adults undergoing RSI, etomidate use was associated with higher in-hospital mortality at 7 and 28 days compared with ketamine. These findings highlight the need for definitive randomized clinical trials to compare both agents.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.48060","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T16:30:55Z","timestamp":1765816255000},"page":"e2548060","source":"Crossref","is-referenced-by-count":8,"title":["Ketamine, Etomidate, and Mortality in Emergency Department Intubations"],"prefix":"10.1001","volume":"8","author":[{"given":"Ian Ward A.","family":"Maia","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil"},{"name":"Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00e9rgio R. R.","family":"Decker","sequence":"additional","affiliation":[{"name":"Outcomes Research Lab, MOVE, Hospital Moinhos de Vento, Porto Alegre, Brazil"},{"name":"Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas","family":"Oliveira J. e Silva","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota"},{"name":"Department of Emergency Medicine, Hospital de Clinicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael","family":"von Hellmann","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Monash Health, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julio C. G.","family":"Alencar","sequence":"additional","affiliation":[{"name":"Universidade de Sao Paulo, Faculdade de Medicina de Bauru, Bauru, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludhmila Abrahao","family":"Hajjar","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia M. Dorn","family":"de Carvalho","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel F.","family":"Pedrollo","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Hospital de Clinicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caio G.","family":"Nogueira","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Hospital Metropolitano Odilon Behrens, Belo Horizonte, Minas Gerais, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia Mansur P.","family":"Figueiredo","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Hospital Metropolitano Odilon Behrens, Belo Horizonte, Minas Gerais, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos Henrique","family":"Miranda","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Ribeirao Preto School of Medicine, University of Sao Paulo, Ribeirao Preto, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danilo","family":"Martins","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Universidade Estadual Paulista, Botucatu, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thiago D.","family":"Baumgratz","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Universidade Estadual Paulista, Botucatu, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Bergesch","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Hospital Regional de Sao Jose Doutor Homero de Miranda Gomes, Florian\u00f3polis, Santa Catarina, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osmar","family":"Colleoni","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Hospital Sao Lucas da Pontificia Universidade Cat\u00f3lica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliana","family":"Zanettini","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Hospital de Pronto Socorro, Porto Alegre, Rio Grande do Sul, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Paula","family":"Freitas","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Hospital de Pronto Socorro, Porto Alegre, Rio Grande do Sul, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renato","family":"Tambelli","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Hospital das Cl\u00ednicas da Faculdade de Medicina de Marilia, Marilia, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Cristina","family":"Costa","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Hospital Augusto de Oliveira Camargo, Indaiatuba, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilsterman","family":"Correia","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Hospital Regional Alto Vale, Rio do Sul, Santa Catarina, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael G.","family":"de Maria","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Hospital Santo Antonio, Sinop, Mato Grosso, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ubirajara A. 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