RSI Trial

In this multicenter RCT (n=2,365), critically ill adults undergoing emergency tracheal intubation were randomized to ketamine (n=1176) or etomidate (n=1189) for anesthesia induction. In-hospital mortality by day 28 was 28.1% with ketamine and 29.1% with etomidate (adjusted risk difference −0.8 percentage points; 95% CI, −4.5 to 2.9; P=0.65). Cardiovascular collapse during intubation occurred more frequently with ketamine (22.1% vs 17.0%; risk difference 5.1 percentage points; 95% CI, 1.9 to 8.3), particularly in patients with sepsis or high illness severity. No significant differences were found in secondary outcomes including ICU-free days, vasopressor-free days, and 24-hour BP readings.