Single-Dose Etomidate for Intubation in the Trauma Patient
The Journal of Emergency Medicine, 05/09/2012
Banh KV et al. – A significant reduction in the use of etomidate in trauma patients was not associated with differences in mortality, ICU days, or hospital length of stay (LOS), but was associated with an increase in episodes of hypotension within 24h of presentation.Methods
- A retrospective review of trauma patients requiring emergent intubation who presented between August 2004 and December 2008, before and after the authors decided to limit the use of etomidate.
- Data were collected on patient demographics, induction agents used, episodes of hypotension in the first 24h, ICU and total hospital LOS, and survival.
- Of 1325 trauma patients intubated in the Emergency Department during the study period, 443 occurred during the 23 months before July 2006 (liberal etomidate use) and 882 in the 30 months after July 2006 (limited etomidate use).
- During the liberal use period, 258/443 (58%) were intubated using etomidate, compared to 205/882 (23%, p<0.0001) during the period of limited use.
- The authors found no significant differences in mortality (30% vs. 29%, p=0.70), mean ICU days (8.2 vs. 8.8, p=0.356), or mean hospital LOS (13.8 vs. 14.4 days, p=0.55).
- Episodes of hypotension were more common in the limited etomidate use group (45% vs. 33%, p<0.0001).