JAMA Netw Open

Ketamine or etomidate for emergency intubation? Mortality risk may tip the scale

December 16, 2025

A Brazilian cohort study emulating a target trial compared etomidate and ketamine for rapid sequence intubation in 1,810 critically ill adults across 18 EDs. Etomidate was associated with significantly higher in‑hospital mortality than ketamine: 60.5 % vs 54.4 % at 28 days (RR 1.14) and 35.2 % vs 30.1 % at 7 days (RR 1.19). New hemodynamic instability within 30 minutes occurred more often with ketamine (24.2% vs. 18.9%), while other adverse events and first-attempt success rates were similar.

Clinical takeaway: Etomidate was associated with greater short-term and 28-day mortality than ketamine, though ketamine carried more early hemodynamic instability—highlighting the need for definitive randomized trials.

Source:

Maia IWA, et al; Brazilian Airway Registry Cooperation (BARCO) group. (2025, December 1). JAMA Netw Open. Ketamine, Etomidate, and Mortality in Emergency Department Intubations. https://pubmed.ncbi.nlm.nih.gov/41396604/