SynthesisClinical and experimental emergency medicine2025
Efficacy of ketamine versus etomidate for rapid sequence intubation of critically ill patients in terms of mortality and success rate: a systematic review and meta-analysis of randomized controlled trials.
Synthesis in Clinical and experimental emergency medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
3 citing papers in PubMed.
- Ketamine or Etomidate for Tracheal Intubation of Critically Ill Adults.The New England journal of medicine · 2026Trial
- [Ketamine or etomidate for emergency intubation of critically ill patients: no mortality benefit with ketamine, but increased hemodynamic instability].Die Anaesthesiologie · 2026Article
- Review
Corrections and comments
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Authors and funding
4 authors.
Funding
Abstract
objectiveEtomidate and ketamine are hemodynamically stable induction agents for rapid sequence intubation (RSI) of critically ill patients. Despite their relative stability in terms of hemodynamics, how the choice of agent affects mortality and the success of the procedure is debatable and has not yet been explored via systematic review and meta-analysis. The objective of this systematic review is to compare the efficacy of ketamine and etomidate for RSI in terms of mortality, hemodynamic parameters, and success rate.
methodsA comprehensive search of PubMed, Embase, and the Web of Science was conducted from the starting date of each database until April 2024. Randomized controlled trials comparing the safety and efficacy of ketamine and etomidate as induction drugs for critically ill patients undergoing RSI were included. The primary outcome was the risk of 28-day mortality, and the secondary outcomes included the success rate and postinduction hypotension. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects meta-analysis.
resultsFour studies with 1,663 patients were meta-analyzed, and no statistically significant difference between the two drugs was found for 28-day mortality (RR, 0.95; 95% CI, 0.72-1.25; heterogeneity I2=39%; level of certainty of evidence per GRADE, moderate), first-pass success rate (RR, 1.00; 95% CI, 0.97-1.03), or postinduction cardiac arrest (RR, 1.10; 95% CI, 0.62-1.96). Postinduction hypotension was higher in the ketamine group (RR, 1.30; 95% CI, 1.03-1.64), but the result was not statistically significant.
conclusionMortality outcomes did not differ when ketamine or etomidate was used for RSI in critically ill patients. Ketamine, however, was associated with a non-significantly higher risk of postinduction hypotension.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.