Intubating conditions and hemodynamic effects of etomidate for rapid sequence intubation in the emergency department: an observational cohort study

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
P J ZedDavid W Harrison

Abstract

To describe and analyze the intubating conditions and hemodynamic effects of etomidate in patients undergoing rapid sequence intubation (RSI) in the emergency department. The authors conducted a prospective observational study of all patients who received etomidate for induction of RSI over a 42-month period in a large tertiary care teaching hospital. Intubating conditions were determined by the emergency physician for both sedation and paralysis and for technical difficulty using a five-point Likert scale. Hemodynamic effects were evaluated before, after, and every five minutes for 15 minutes following administration of etomidate. Etomidate was used for induction of RSI in 522 patients, all of whom were included in the final efficacy analysis, while 491 were included in the analysis of hemodynamics. Lidocaine and fentanyl were used as pretreatment in 65.1% and 26.1% of patients, respectively, while succinylcholine was the paralytic in 94.3% of intubations. Sedation and paralysis were rated as excellent or good in 88.1% and 8.8% of patients, respectively, while technical difficulty was very easy or easy in 60.7% and 19.0% of patients, respectively. Mean (+/- SD) baseline systolic blood pressure (sBP), diastolic blood pressure (...Continue Reading

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