The impact of etomidate on mortality in trauma patients
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INTRODUCTION: Etomidate has a neutral hemodynamic profile which has made it an attractive medication for emergent intubation. Despite theoretical advantages of etomidate administration in the trauma patient, there are incomplete data to support its use. This study examined the association of etomidate use for emergent intubation in traumatic illness with patient mortality. METHODS: This is a historical cohort study using the Nova Scotia Trauma Registry. It included all major adult trauma patients who required tracheal intubation at the Queen Elizabeth II Health Sciences Centre in Halifax, Canada from January 23, 2000 to March 25, 2012. Prospectively recorded data were analyzed, including patient demographics, presence of comorbidities, trauma specific variables, admission and discharge vitals, length of stay in the intensive care unit (ICU) and hospital, mechanical ventilation-free days, and mortality. Associations between the use of etomidate and 28-day mortality are presented as odds ratios. Multivariable logistic regression models were created adjusting for age, injury severity score (ISS), sex, comorbidities, presence of traumatic brain injury, and injury type. The effects of etomidate on other relevant outcome variables were assessed using unpaired Student's t-tests. RESULTS: Three hundred eight patients were included in the study, and there were 42 deaths. Patients receiving etomidate were similar to those who did not, including ISS and pre-intubation blood pressure. The 28-day mortality was 18.7% in the etomidate group and 11.1% in the non-etomidate group (odds ratio = 1.85; 95% confidence interval [CI] 0.96 to 3.57; P = 0.07). After adjustment for age, female sex, ISS, and comorbidity, the odds ratio was 1.94 (95% CI 0.87 to 4.37; P = 0.11). There were no differences between the two groups in ICU length of stay, hospital length of stay, or number of ventilation-free days. CONCLUSION: The association between use of a single dose of etomidate for emergency tracheal intubation in the trauma patient and mortality is inconclusive. Etomidate administration should be used with caution in trauma patients requiring tracheal intubation. Further data are required to determine the safety and risk-benefit of etomidate use in this patient population.
