Ketamine or Etomidate for Tracheal Intubation of Critically Ill Adults Casey. NEJM. 2025. doi: 10.1056/NEJMoa2511420
- The RSI trial demonstrated no difference in 28‑day mortality between etomidate (0.2–0.3 mg/kg IV, actual body weight) and ketamine (1–2 mg/kg IV, actual body weight) when used for induction during rapid sequence intubation
- Cardiovascular collapse occurred frequently in both groups, but was more common with ketamine (22%) than with etomidate (17%) (NNH = 20). Among patients with sepsis or an APACHE II score >20, the excess risk associated with ketamine was even greater (NNH = 10)
- These findings warrant reconsideration of current practice, although the trial does not clarify whether reduced‑dose ketamine, etomidate, or delayed sequence intubation offers a safer alternative for critically ill patients at high risk of cardiovascular collapse