WEDNESDAY, Dec. 17, 2025 (HealthDay News) -- Use of ketamine to induce anesthesia does not result in lower in-hospital death by day 28 compared with etomidate among critically ill adults undergoing tracheal intubation, according to a study published online Dec. 9 in the New England Journal of Medicine.
Jonathan D. Casey, M.D., from the Vanderbilt University Medical Center in Nashville, Tennessee, and colleagues conducted a randomized trial in 14 emergency departments and intensive care units in the United States involving critically ill adults who were undergoing tracheal intubation. Participants were randomly assigned to receive ketamine or etomidate for induction of anesthesia (1,176 and 1,189 participants, respectively).
The researchers found that in-hospital death by day 28 occurred in 28.1 and 29.1 percent of patients in the ketamine and etomidate groups, respectively (risk difference adjusted for trial site, −0.8 percentage points; 95 percent confidence interval, −4.5 to 2.9; P = 0.65). Cardiovascular collapse during intubation occurred in 22.1 and 17.0 percent of patients in the ketamine and etomidate groups, respectively (risk difference, 5.1 percentage points; 95 percent confidence interval, 1.9 to 8.3). The two groups had similar prespecified safety outcomes.
"We found that etomidate is safe and that ketamine can cause severely low blood pressure during intubation. Going forward, many clinicians will choose to use etomidate rather than ketamine," co-lead author Matthew Semler, M.D., also of the Vanderbilt University Medical Center, said in a statement. "These findings emphasize why more research must focus not just on the development of new drugs and devices, but also on understanding which treatments patients are already receiving produce the best outcomes."
Several authors disclosed ties to the biopharmaceutical and medical technology industries.