Etomidate versus Ketamine as prehospital induction agent in patients with suspectedsevere traumatic brain injury

BRAIN-PROTECT collaborators, Floor J Mansvelder*, Sebastiaan M Bossers, Stephan A Loer, Frank W Bloemers, Esther M M Van Lieshout, Dennis Den Hartog, Nico Hoogerwerf, Joukje van der Naalt, Anthony R Absalom, Saskia M Peerdeman, Carolien S E Bulte, Lothar A Schwarte, Patrick Schober

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

INTRODUCTION: Severe traumatic brain injury (TBI) is a leading cause of morbidity and mortality among young people around the world. Prehospital care focusses on the prevention and treatment of secondary brain injury and commonly includes tracheal intubation after induction of general anesthesia. The choice of induction agent in this setting is controversial. We therefore investigated the association between the chosen induction medication etomidate versus S(+)-ketamine , and the 30-day mortality in patients with severe TBI who received prehospital airway management in the Netherlands.

METHODS: We conducted a retrospective analysis of the prospectively collected observational data of the BRAIN-PROTECT cohort study. Patients with suspected severe TBI, who were transported to a participating trauma center and who received etomidate or S(+)-ketamine for prehospital induction of anesthesia for advanced airway management were included. Statistical analyses were performed with multivariable logistic regression and Inverse Probability of Treatment Weighting analysis.

RESULTS: In total, 1457 patients were eligible for analysis. No significant association between the administered induction medication and 30-day mortality was observed in unadjusted analyses (etomidate 32.9% mortality versus S(+)-ketamine 33.8% mortality, p= 0.716, OR 1.04, 95% CI 0.83 to 1.32, p= 0.711) as well as after adjustment for potential confounders (OR 1.08, 95% CI 0.67 to 1.73, p= 0.765; risk difference 0.017, 95% CI -0.051 to 0.084, p= 0.686). Likewise, in planned subgroup analyses for patients with confirmed TBI and patients with isolated TBI, no significant differences were found. Consistent results were found after multiple imputation of missing data.

CONCLUSIONS: We found no evidence for an association between the use of etomidate or S(+)-ketamine as an anesthetic agent for intubation in patients with TBI and mortality after 30 days in the prehospital setting, suggesting that the choice of induction agent may not influence patient mortality rate in this population.

Original languageEnglish
Pages (from-to)742-751
Number of pages10
JournalAnesthesiology
Volume140
Issue number4
Early online date8-Jan-2024
DOIs
Publication statusPublished - 1-Apr-2024

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