This systematic review pooled seven randomized trials involving 5234 critically ill adults undergoing emergency intubation with etomidate or ketamine. Etomidate versus ketamine showed no statistically significant difference in 28-day mortality (RR 1.01; 95% CI 0.93-1.10) or cardiac arrest (RR 0.91; 95% CI 0.62-1.34). Failed intubation (RR 1.09; 95% CI 0.68-1.76) and vasopressor requirement (RR 1.27; 95% CI 0.94-1.72) also did not differ significantly. Sensitivity analyses suggested possible haemodynamic differences, with relative cardiovascular stability for etomidate in some analyses, but these findings require cautious interpretation.
The pooled trials did not demonstrate a mortality difference between induction agents. Uncertainty around cardiac arrest and vasopressor estimates precludes interpreting these findings as equivalence.
Study limitation: The abstract provides no cardiac ICU-specific subgroup results, limiting assessment of applicability to patients with cardiovascular critical illness.
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