N Engl J Med

Ketamine shows no survival advantage over etomidate for critically ill intubations

December 12, 2025

A multicenter randomized trial (NCT05277896) of 2,365 critically ill adults found no difference in 28‑day mortality between ketamine (28.1%) and etomidate (29.1%; risk difference adjusted for trial site, −0.8 percentage points; 95% confidence interval, -4.5 to 2.9; P=0.65) but showed significantly more CV collapse—defined as severe hypotension or need for vasopressors—among ketamine recipients (22.1% vs. 17.0%).

Clinical takeaway: Choose etomidate over ketamine for hemodynamic stability during emergent intubation in critically ill adults unless contraindicated.

Source:

Casey JD, et al; RSI Investigators and the Pragmatic Critical Care Research Group. (2025, December 9). N Engl J Med. Ketamine or Etomidate for Tracheal Intubation of Critically Ill Adults. https://pubmed.ncbi.nlm.nih.gov/41369227/