A prospective observational study of the effect of etomidate on septic patient mortality and length of stay.
OBJECTIVE
Etomidate is known to cause adrenal suppression after single-bolus administration. Some studies suggest that when etomidate is used as an induction agent for intubation of septic patients in the emergency department (ED), this adrenal suppression leads to increased mortality, vasopressor requirements, and length of hospital stay. The authors sought to determine differences in the in-hospital mortality and hospital length of stay (LOS) between septic patients given etomidate and patients given alternative or no induction agents for rapid-sequence intubation in our ED.


METHODS
This was a nonrandomized, prospective observational study of all patients meeting sepsis criteria who were intubated in an ED over a 9-month period. Times of patient presentation, intubation, admission, discharge, and/or death were recorded, as well as the intubation agent used, if any, and corticosteroid use. The authors also recorded relevant laboratory and demographic variables to determine severity of illness using the Mortality in Emergency Department Sepsis (MEDS) score. Mortality and survivor LOS between the patients given etomidate and those given alternative or no induction agents were compared.


RESULTS
A total of 106 patients with sepsis were intubated over the study period. Of these, 74 patients received etomidate, while 32 patients received ketamine, benzodiazepines, propofol, or no induction agents. Age in years (median = 78; interquartile range [IQR] = 67 to 83), gender (45% male), MEDS score (median = 13; IQR = 10 to 15), and receipt of supplemental corticosteroids (56%) were statistically similar between the two groups. In-hospital mortality of patients given etomidate (38%; 95% confidence interval [CI] = 28% to 49%) was similar to those receiving alternatives (44%; 95% CI = 28% to 61%). Surviving patients had a median hospital LOS after receiving etomidate of 10 days compared to those receiving alternatives (7.5 days; p = 0.08).


CONCLUSIONS
No statistically significant increase in hospital LOS or mortality in patients given etomidate for rapid-sequence intubation was found. Suggestions that the use of etomidate for intubation in the ED be abandoned are not supported by these data.
Tekwani
Karis L
KL
Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, IL, USA. karistekwani@gmail.com
Watts
Hannah F
HF
Rzechula
Kathleen H
KH
Sweis
Rolla T
RT
Kulstad
Erik B
EB
D000368:Aged; D000369:Aged, 80 and over; D018686:Anesthetics, Intravenous / Q000009:adverse effects*; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods; D005045:Etomidate / Q000009:adverse effects*; D017052:Hospital Mortality; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods; D007902:Length of Stay; D016014:Linear Models; D019370:Observation; D011446:Prospective Studies; D018805:Sepsis / Q000401:mortality*
D018686:Anesthetics, Intravenous; D005045:Etomidate