Critical Care Time 65. The RSI Trial: Ketamine vs Etomidate
Dec 29, 2025
Dive into the exciting world of critical care as hosts discuss the newly released RSI Trial. They explore whether ketamine or etomidate is superior for intubation in critically ill adults. Key topics include operator experience and its impact on outcomes, the nuances of drug dosing, and implications for practice. Interesting insights emerge on intubation times, mortality rates, and the role of vasopressors. Ultimately, they emphasize that the right dose may outweigh the choice of drug. A thought-provoking listen for medical professionals!
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Trial Population And Operator Mix Matter
- The RSI Trial randomized 2,365 critically ill adults to ketamine vs etomidate across EDs and ICUs.
- Most airway operators were trainees, which may affect generalizability and decision-making.
Dose Variability Could Drive Outcomes
- Median ketamine dose was 1.6 mg/kg (140 mg) and etomidate 20 mg (0.28 mg/kg), both by actual body weight.
- Dosing varied widely with some very high ketamine doses, raising concerns about dose-dependent effects.
Practice Patterns And Timing Differences
- Video laryngoscopy was used in 95% of intubations and first-pass success was 85%.
- Time from induction to laryngoscopy/intubation was ~8–9 seconds longer with ketamine.