Induction drug choice during emergency intubation has always carried strong opinions.
Etomidate is often favored for hemodynamic stability but raises concern for adrenal suppression. Ketamine is attractive because it provides dissociation, analgesia, and sympathetic stimulation, but it can still cause hypotension in catecholamine-depleted patients.
The newer randomized evidence helps clarify the debate.
The RSI trial compared ketamine with etomidate for induction of anesthesia in critically ill adults undergoing tracheal intubation in emergency departments and ICUs.
The primary outcome was in-hospital death by day 28.