Authors: Gu WJ., Chest 2014 Sep 25;
A meta-analysis finds no evidence of harm.
Etomidate causes laboratory abnormalities, specifically, suppression of cortisol production. Prior authors have attempted to demonstrate corresponding patient harm (NEJM JW Emerg Med Jan 16 2014). A new meta-analysis of two randomized, controlled trials and 16 observational studies involving 5552 patients helps us to draw conclusions from the totality of the evidence.
Pooled analysis revealed that single-dose etomidate increased risk for laboratory evidence of adrenal insufficiency (relative risk, 1.4), but did not significantly increase risk for mortality.
Perhaps finally we can put the “etomidate controversy” to rest. Both ketamine and etomidate are appropriate choices for intubation of septic patients. There is no credible evidence that either agent causes harm or is inferior to the other.