By Mike McEvoy
EMS Editor
Researchers reporting in the February 2013 issue of Critical Care Medicine on their study of a large electronic database of intensive care unit (ICU) patients could not find an association between mortality and single dose etomidate given to septic patients. In fact, etomidate could not be associated with use of pressors, ICU or hospital length of stay, time on the ventilator, or the incidence of shock.
This very large study runs contradictory to a series of others that have severely curtailed use of etomidate for emergency intubation citing adrenocortical suppression leading to an observed increase in mortality. Subsequent steroid administration has not seemed to decrease mortality. One consequence has been a decrease in prehospital use of etomidate despite its popularity as an induction drug for emergency intubation, its rapid onset and lesser likelihood of causing hypotension. Perhaps this newer and larger study will alleviate some anxiety.
Reference:
McPhee LC, et al. Single-Dose Etomidate Is Not Associated With Increased Mortality in ICU Patients With Sepsis: Analysis of a Large Electronic ICU Database. Crit Care Med. 2013;41:epublished ahead of print.
MIKE McEVOY, PhD, NRP, RN, CCRN is the EMS Coordinator for Saratoga County, NY and the Fire Engineering EMS editor. He is a professor emeritus of critical care medicine at Albany Medical College in New York and continues to practice as a clinical nurse specialist in the Cardiac Surgical ICUs at Albany Medical Center. Mike is a paramedic for Clifton Park & Halfmoon Ambulance and the Chief Medical Officer for West Crescent Fire Department. He is a Board Member of the New York State Association of Fire Chiefs and a popular speaker at Fire, EMS, and medical conference worldwide.
