title: The use of etomidate for prehospital rapid-sequence intubation.
abstract: Prehospital hypoxia and hypotension increase morbidity and mortality in head-injured patients. Etomidate is a sedative agent with increasing use for emergent rapid-sequence intubation (RSI) because of its favorable hemodynamic profile. This prospective, observational study documents the authors' preliminary experience with etomidate as part of an aeromedical RSI protocol. Major trauma victims received etomidate 0.1 to 0.3 mg/kg intravenously (IV) before administration of a neuromuscular-blocking agent. After confirmation of endotracheal tube position, 1 to 2 mg midazolam IV was administered. The main outcome measure was systolic blood pressure (SBP) before and after the RSI procedure and the incidence of hypotension after RSI; individual patient plots of SBP versus time were also included for graphic analysis. An improvement in SBP after RSI with etomidate was observed (123 mm Hg to 136 mm Hg, p = 0.011) with a 9% incidence of hypotension, defined as a decrease in SBP to 90 mm Hg or less. Graphic analysis of individual SBP-time plots reveals hemodynamic stability, especially in patients with lower initial SBP values. These data suggest that the use of etomidate as part of a prehospital RSI protocol is associated with hemodynamic stability and a low incidence of hypotension.
authors.affiliation: UCSD Emergency Medicine, San Diego, California 92103-8676, USA.
authors.forename: Sean
authors.initials: S
authors.lastname: Deitch
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Davis
authors.forename: Jeff
authors.initials: J
authors.lastname: Schatteman
authors.forename: Theodore C
authors.initials: TC
authors.lastname: Chan
authors.forename: Gary M
authors.initials: GM
authors.lastname: Vilke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017732:Air Ambulances / Q000592:standards*; D001794:Blood Pressure / Q000187:drug effects*; D002140:California; D002648:Child; D002985:Clinical Protocols; D006259:Craniocerebral Trauma / Q000628:therapy*; D004638:Emergency Treatment / Q000379:methods* / Q000592:standards; D005045:Etomidate / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D007022:Hypotension / Q000139:chemically induced; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019370:Observation; D011446:Prospective Studies
chemical_list: D006993:Hypnotics and Sedatives; D005045:Etomidate