PDF(Pubmed)
Abstract：
OBJECTIVE: The objective of the study was to compare the safety and efficacy of etomidate and ketamine as induction agents for rapid sequence intubation (RSI) in acutely ill patients in emergency department and prehospital settings with respect to post-induction hypotension and first-pass intubation success during RSI.
METHODS: For this systematic review and meta-analysis, we searched PubMed, Embase, Cochrane, and ClinicalTrials.gov between database inception and June 1, 2021. Articles were included if they compared safety and efficacy of etomidate vs ketamine as induction agents, in patients undergoing RSI in emergency department and prehospital settings, without any restrictions on study design. The outcome measures were incidence of post-induction hypotension and first-pass intubation success. The dichotomous outcomes were assessed for odds ratio (OR) with 95% confidence interval (CI) using random-effects meta-analysis.
RESULTS: Of 87 records identified, 9 were eligible, all assessed as having a low to moderate risk of overall bias. Six studies, including 12,060 patients from prehospital emergency medical services, air medical transport, and emergency department settings, compared post-induction hypotension incidence between etomidate and ketamine groups. The meta-analysis showed that etomidate was associated with decreased risk of post-induction hypotension compared to ketamine (OR: 0.53; 95% CI: 0.31-0.91; I 2 = 68%). Seven studies, including 15,574 patients, reported on the rate of first-pass intubation success with etomidate vs ketamine. In the pooled analysis, no differences were seen in first-pass intubation success during RSI using etomidate vs ketamine as the induction agent (OR: 1.13; 95% CI: 0.95-1.36; I 2 = 16%).
CONCLUSIONS: The use of etomidate for induction during RSI is associated with a decreased risk of post-induction hypotension as compared to the use of ketamine, without an impact on the first-pass intubation success rate.
UNASSIGNED: Sharda SC, Bhatia MS. Etomidate Compared to Ketamine for Induction during Rapid Sequence Intubation: A Systematic Review and Meta-analysis. Indian J Crit Care Med 2022;26(1):108-113.
METHODS: For this systematic review and meta-analysis, we searched PubMed, Embase, Cochrane, and ClinicalTrials.gov between database inception and June 1, 2021. Articles were included if they compared safety and efficacy of etomidate vs ketamine as induction agents, in patients undergoing RSI in emergency department and prehospital settings, without any restrictions on study design. The outcome measures were incidence of post-induction hypotension and first-pass intubation success. The dichotomous outcomes were assessed for odds ratio (OR) with 95% confidence interval (CI) using random-effects meta-analysis.
RESULTS: Of 87 records identified, 9 were eligible, all assessed as having a low to moderate risk of overall bias. Six studies, including 12,060 patients from prehospital emergency medical services, air medical transport, and emergency department settings, compared post-induction hypotension incidence between etomidate and ketamine groups. The meta-analysis showed that etomidate was associated with decreased risk of post-induction hypotension compared to ketamine (OR: 0.53; 95% CI: 0.31-0.91; I 2 = 68%). Seven studies, including 15,574 patients, reported on the rate of first-pass intubation success with etomidate vs ketamine. In the pooled analysis, no differences were seen in first-pass intubation success during RSI using etomidate vs ketamine as the induction agent (OR: 1.13; 95% CI: 0.95-1.36; I 2 = 16%).
CONCLUSIONS: The use of etomidate for induction during RSI is associated with a decreased risk of post-induction hypotension as compared to the use of ketamine, without an impact on the first-pass intubation success rate.
UNASSIGNED: Sharda SC, Bhatia MS. Etomidate Compared to Ketamine for Induction during Rapid Sequence Intubation: A Systematic Review and Meta-analysis. Indian J Crit Care Med 2022;26(1):108-113.
摘要：
目的：本研究的目的是比较依托咪酯和氯胺酮作为快速序列插管（RSI）诱导剂在急诊科和院前急症患者中，在RSI期间诱导后低血压和首过插管成功方面的安全性和有效性。
方法：对于本系统综述和荟萃分析，我们搜索了PubMed,Embase,科克伦,和ClinicalTrials.gov从数据库开始到2021年6月1日。如果他们比较依托咪酯与氯胺酮作为诱导剂的安全性和有效性，在急诊科和院前环境中接受RSI的患者中，对研究设计没有任何限制。结果指标是诱导后低血压的发生率和首次插管成功。使用随机效应荟萃分析以95％置信区间（CI）评估二分结果的比值比（OR）。
结果：在确定的87条记录中，9有资格全部评估为总体偏倚的风险为低至中度.六项研究,包括院前急救医疗服务的12060名患者，航空医疗运输，和急诊科设置，比较依托咪酯和氯胺酮组诱导后低血压的发生率。荟萃分析显示，与氯胺酮相比，依托咪酯与诱导后低血压的风险降低相关（OR：0.53；95％CI：0.31-0.91；I2=68％）。七项研究,包括15574名患者,报道了依托咪酯与氯胺酮的首过插管成功率。在汇总分析中，在使用依托咪酯和氯胺酮作为诱导剂的RSI期间,首过插管成功率没有差异(OR:1.13;95%CI:0.95~1.36;I2=16%).
结论：与使用氯胺酮相比，在RSI期间使用依托咪酯进行诱导与诱导后低血压的风险降低相关，不影响首过插管成功率。
未经批准：ShardaSC，Bhatia女士依托咪酯与氯胺酮在快速序列插管诱导中的比较：系统评价和Meta分析。印度JCritCareMed2022；26（1）：108-113。
方法：对于本系统综述和荟萃分析，我们搜索了PubMed,Embase,科克伦,和ClinicalTrials.gov从数据库开始到2021年6月1日。如果他们比较依托咪酯与氯胺酮作为诱导剂的安全性和有效性，在急诊科和院前环境中接受RSI的患者中，对研究设计没有任何限制。结果指标是诱导后低血压的发生率和首次插管成功。使用随机效应荟萃分析以95％置信区间（CI）评估二分结果的比值比（OR）。
结果：在确定的87条记录中，9有资格全部评估为总体偏倚的风险为低至中度.六项研究,包括院前急救医疗服务的12060名患者，航空医疗运输，和急诊科设置，比较依托咪酯和氯胺酮组诱导后低血压的发生率。荟萃分析显示，与氯胺酮相比，依托咪酯与诱导后低血压的风险降低相关（OR：0.53；95％CI：0.31-0.91；I2=68％）。七项研究,包括15574名患者,报道了依托咪酯与氯胺酮的首过插管成功率。在汇总分析中，在使用依托咪酯和氯胺酮作为诱导剂的RSI期间,首过插管成功率没有差异(OR:1.13;95%CI:0.95~1.36;I2=16%).
结论：与使用氯胺酮相比，在RSI期间使用依托咪酯进行诱导与诱导后低血压的风险降低相关，不影响首过插管成功率。
未经批准：ShardaSC，Bhatia女士依托咪酯与氯胺酮在快速序列插管诱导中的比较：系统评价和Meta分析。印度JCritCareMed2022；26（1）：108-113。
