T HE U SE OF E TOMIDATE FOR R APID - SEQUENCE I NTUBATION IN THE A IR M EDICAL S ETTING

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Abstract
Objective. To describe the use of etomidate for rapid-sequence intubation (RSI) in the air medical environment. Methods. This was a retrospective review of a consecutive series of patients receiving etomidate for RSI by a university hospital-based air medical program. Records of all patients more than 10 years of age requiring intubation during a 13-month period were reviewed. Data collected included demographics, site of intubation, person performing intubation, indication, diagnosis, medications administered, complications, and pre- and post-RSI vital signs. Results. Of 79 patients who underwent intubation, 53 (67%) received etomidate for RSI. Forty-two (79%) patients who received etomidate were also given succinylcholine. The overall intubation success rate was 96%. Two patients required a cricothyrotomy. Hemodynamic data were complete for 46 patients. The average systolic blood pressures (SBPs) were 139.11 ± 31.21 mm Hg prior to RSI and 137.85 ± 32.00 mm Hg after RSI. These were not significantly different (p = 0.82). The mean change in SBP was −1.26 ± 37.03 mm Hg (95% CI −6.61 to 4.09). The average heart rates (HRs) were 101.59 ± 23.95 beats/min prior to RSI and 97.76 ± 23.45 beats/min after RSI. These were also not significantly different (p = 0.15). The mean change in HR was −3.52 ± 15.67 beats/min (95% CI −5.79 to −1.26). Conclusion. This study supports the safety of etomidate for RSI in the air medical setting. The intubation success rate was comparable to those in other studies evaluating RSI. There was no significant change in average SBP or HR during RSI.

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