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Purpose: Etomidate is the most commonly used induction agent for rapid sequence intubation (RSI). Single-dose etomidate may inhibit cortisol production for 72 hours. The impact of etomidate-induced adrenal suppression in critically ill trauma patients has not been fully elucidated. The primary outcome was to compare in-hospital mortality for traumatically injured patients receiving etomidate versus alternative induction agents for RSI.
Methods: A single-center, retrospective review was performed of medical records for 202 traumatically injured adult patients between July 2008 and March 2010. Patients were identified through an institutional trauma registry and data were collected from medical records.
Results: The patient population was mostly male (72.8%) with a median age of 44 years. More patients were intubated in the ED than prior to arrival (56% vs. 44%). Motor vehicle accident was the most frequently reported mechanism of injury (n=71). Etomidate was used in 130 cases (63%), while 72 patients received alternative sedatives including midazolam (n=45), propofol (n=8), ketamine (n=4), or no induction therapy (n=15). ISS (22 vs. 26, p=0.18) and SOFA scores (6 vs. 6, p=0.20) were similar at baseline between etomidate and non-etomidate groups, respectively. Intravenous fluids (4.6 L vs. 4.8 L, p=0.87) and units of packed red blood cells (pRBCs) received (4 vs. 4, p=0.28) were similar for both etomidate and non-etomidate groups during the first 24 hours following injury. In-hospital mortality rates were similar between groups (11.5% vs. 12.5%, p=0.82). ICU LOS (8.5 vs. 8 days, p=0.45), hospital LOS (14.5 vs. 13.5 days, p=0.68), ventilator days (6 vs. 5, p=0.61), and vasopressor days (6 vs. 5, p=0.60) were not significantly different.
Conclusion: Etomidate use does not appear to be associated with increased in-hospital mortality or resource utilization when used for RSI induction in traumatically injured patients.