2025 Southeastern Residency Conference

Title: Evaluation of Rapid Sequence Intubation Agent Selection on Hemodynamics in Emergency Room Patients


Authors: Jaclyn Gruver, Thomas Neal, Tracey Bastian, Valerie Van Vickle


Background: Rapid sequence intubation (RSI) is the process of administering a sedative induction agent and a paralytic agent to assist endotracheal intubation. The goal of induction is to induce general anesthesia, which allows for the administration of paralytics and the facilitation of optimal intubating settings. Shock index (SI) has been used by some emergency departments as a clinical severity score. It is defined as heart rate (HR) divided by systolic blood pressure (SBP) and normally ranges from 0.5 to 0.7. An SI greater than 0.9 is linked to increased risk for decompensation and poor outcomes. The purpose of this study is to evaluate the impact of induction agent selection (etomidate, ketamine, and propofol) on peri-/post- intubation hemodynamics after RSI in Emergency Room (ER) patients.


Methods: This study was an Institutional Review Board approved, single-center, retrospective chart review evaluating patients aged 18 years and older who were intubated in the ER, received one of the induction agents for RSI (etomidate, ketamine, or propofol), and survived to hospital admission. Patients who were intubated in the ER from January 1, 2022 to August 31, 2024 were identified using data from a medication dispensing cabinet report for the intubation kit, which included the induction agents. The primary objective is to evaluate the differences in pre-intubation and post-intubation shock index between etomidate, ketamine, and propofol. Secondary endpoints include: incidence of bradycardia (HR < 60 bpm) within 30 minutes of intubation, tachycardia (HR > 100 bpm) within 30 minutes of intubation, hypertension (SBP > 140 mmHg or DBP > 90 mmHg) within 30 minutes of intubation, hypotension (SBP < 90 mmHg or DBP < 60 mmHg) within 30 minutes of intubation, treatment of hypotension within 30 minutes of intubation, and dose of agent used for RSI. The safety outcome is 28 day ventilator-free days (VFD).


Results: In progress.


Conclusion: In progress.