Is Ketamine really the "hemodynamically stable" hero of airway management, or have we been unfairly vilifying Etomidate for decades? The debate over the perfect induction agent for critically ill patients just got a major influx of data that flips conventional wisdom on its head .

In this episode, we break down the landmark "RSI" trial, a massive multicenter randomized controlled study involving over 2,300 critically ill adults in EDs and ICUs across the US . The headline results are a shocker: Ketamine did not reduce 28-day mortality compared to Etomidate . Even more surprising? The "hemodynamically neutral" reputation of Ketamine took a hit. Patients randomized to Ketamine actually experienced significantly higher rates of cardiovascular collapse—including hypotension and increased vasopressor needs—during intubation compared to those receiving Etomidate .

We unpack what this means for your next shift: why the theoretical fears of Etomidate-induced adrenal suppression didn't translate to patient harm, and why Ketamine might be less forgiving in shock states than we previously thought . Tune in as we dissect the data and discuss whether it’s time to stop hesitating and reach for the Etomidate.

Ketamine or Etomidate for Tracheal Intubation of Critically Ill Adults