(1125) Ketamine Versus Etomidate for Intubation in Critical Care: A Meta-Analysis of Randomized Trials

Introduction: The selection of an induction agent for intubation in critically ill patients is pivotal, with ketamine and etomidate being two prominent options. Previous research has provided valuable insights into this comparison. This meta-analysis builds on previous findings by rigorously comparing the impact of these agents on mortality, with a particular focus on individuals with chronic obstructive pulmonary disease (COPD) and those requiring intubation due to respiratory failure.

Methods: A systematic literature review was conducted to identify randomized clinical trials that compared ketamine and etomidate for intubation in critically ill patients. Six studies met the inclusion criteria for the primary meta-analysis. The overall effect size was estimated using a random-effects model, and heterogeneity was evaluated via the I² statistic and tau-squared. Meta-regression analyses were performed to assess mortality rates while accounting for COPD history and respiratory failure as the reason for intubation.

Results: The primary meta-analysis encompassed six randomized clinical trials, revealing a p value of 0.476, a Z value of -0.713, an I² of 0%, and a tau-squared of 0.000. These results indicate no significant difference in mortality between ketamine and etomidate and an absence of heterogeneity. Meta-regression analyses of four studies reporting COPD history or respiratory failure as the reason for intubation demonstrated p>t values greater than 0.05, indicating no significant influence of these factors on mortality outcomes.

Conclusions: This comprehensive meta-analysis found no statistically significant difference in mortality between ketamine and etomidate for intubation in critically ill patients. Additionally, neither COPD history nor respiratory failure as the reason for intubation significantly affected mortality outcomes. These findings underscore the versatility of both agents and suggest that clinical factors and practitioner preference can guide their selection. This study provides valuable insights for critical care practice, offering evidence to inform the choice of induction agents in diverse patient populations.