Evaluating the Hemodynamic Effects of Ketamine Versus Etomidate During Rapid Sequence Intubation

NCT ID: NCT03545503

Last Updated: 2021-11-26

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

428 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-01-01

Study Completion Date

2019-09-01

Brief Summary

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The purpose of this study is to compare the hemodynamic effects of ketamine v etomidate during rapid sequence intubation (RSI) in the pre-hospital and emergency department setting.

Detailed Description

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This is a randomized prospective study evaluating the hemodynamic response in adult participants greater than or equal to 18 years of age undergoing RSI in the pre-hospital or emergency department setting. Hemodynamic response is the cardiology response of the circulatory system. The investigators will compare the drugs Ketamine and Etomidate in participants having RSI. Ketamine and Etomidate are immediately available for RSI in both settings as both are currently standards of care for RSI.

Research thus far demonstrates that both Etomidate and ketamine are safe and effective for RSI. Despite the reported safety of Ketamine, Etomidate usage continues to far surpass that of ketamine. Both Etomidate and Ketamine are FDA-approved for induction of anesthesia. They are both ideal drugs for intubation due to their pharmacokinetic properties including a quick onset of less than 60 seconds, a short duration of about 10 minutes, and the minimal effect they have on the cardiovascular system. The neutral effect on the cardiovascular system is particularly important in the acute and traumatic setting when patients are often hypotensive.

However, there are some differences and disadvantages in the two medications. Due to these factors and limited data to support Ketamine as an equal or superior alternative to Etomidate, it has been difficult to clearly recommend one agent over the other for RSI.

Data will be analyzed using SPSS with a p-value of less than 0.05 being considered significant. The PI will consider a 20% decrease in systolic BP from a participant baseline as significant, and will compare the incidence of post RSI hypotension between the two groups. Several a priori subgroups will be evaluated to include patients greater than 70 years of age, trauma participants requiring RSI, and those participants whose shock index is less than 0.9 versus those whose shock index is greater than 0.9.

To maintain 80% power with a probability of 0.05, 200 participants will be needed in each arm to detect at 25% difference in SBP (baseline to post drug administration effects)

Conditions

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Intubation Complication

Keywords

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Rapid Sequence Intubation Hemodynamics Etomidate Ketamine

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Etomidate

Etomidate will be dosed once at a standard of 0.3 mg/kg via IV Push

Group Type ACTIVE_COMPARATOR

Etomidate

Intervention Type DRUG

Etomidate will be administered as the sedative for RSI on even days

Ketamine

Ketamine will be dosed once at a standard 2 mg/kg via IV Push

Group Type ACTIVE_COMPARATOR

Ketamine

Intervention Type DRUG

Ketamine will be administered as the sedative for RSI on odd days

Interventions

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Etomidate

Etomidate will be administered as the sedative for RSI on even days

Intervention Type DRUG

Ketamine

Ketamine will be administered as the sedative for RSI on odd days

Intervention Type DRUG

Other Intervention Names

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Amidate Ketalar

Eligibility Criteria

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Inclusion Criteria

* Persons greater than 18yrs requiring rapid sequence intubation for any reason.

Exclusion Criteria

* Pregnant patients
* Children under the age of 18
* Patients with a known hypersensitivity to etomidate or ketamine
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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New Hanover Regional Medical Center

OTHER

Sponsor Role collaborator

South East Area Health Education Center, Wilmington, NC

OTHER

Sponsor Role lead

Responsible Party

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William F Powers, IV, MD

Assistant Professor of Surgery

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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William F Powers IV, MD

Role: PRINCIPAL_INVESTIGATOR

New Hanover Regional Medical Center

Locations

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New Hanover Regional Medical Center

Wilmington, North Carolina, United States

Site Status

Countries

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United States

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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1712-4

Identifier Type: -

Identifier Source: org_study_id