Rapid Sequence Intubation, Trauma
Conditions
Keywords
trauma, induction medications, rapid sequence intubations, outcomes
Brief summary
To compare the outcomes of the use of propofol, etomidate, and ketamine as induction agents for adult trauma patients undergoing intubation within 24 hours of admission. The primary goal is to determine the ideal agent that should be used in this patient population for intubations.
Detailed description
Rationale: Although rapid sequence intubation (RSI) is commonly used in the emergency department (ED) or operating room (OR) for trauma patients, there is not one induction medication which has been deemed the drug of choice for this particular use. There is a wide variation in induction agents used by providers performing RSIs, including propofol, ketamine, methohexital, midazolam, fentanyl, and etomidate. However, no society guidelines exist on the induction agent of choice in trauma for either hemodynamically stable or unstable patients. The purpose of this study is to compare the effects of 3 of the most commonly used induction agents (propofol, etomidate, and ketamine) for RSIs in adult trauma patients on outcomes, such as mortality, and hemodynamic status. Ultimately, the investigators would like to lay the groundwork for developing guidelines that define the ideal induction agent for trauma RSIs. Intervention: Giving propofol, ketamine, or etomidate as the induction medication for a rapid sequence intubation in trauma patients requiring intubation within 24 hours of admission. Objectives/Purpose: The purpose of this study is to compare the effects of 3 of the most commonly used induction agents (propofol, etomidate, and ketamine) for RSIs in adult trauma patients on outcomes such as mortality. Additionally, how each agent effects patients' hemodynamic status will be evaluated. Additional outcomes of these medications will be studied in three subsets of patients: 1. those with traumatic brain injuries, 2. elderly patients (\>=65-years-old), and 3. those with a low shock index (\<0.9) compared to a high shock index (\>0.9). Finally, the practices and outcomes of RSIs performed in the ED versus the OR will be compared. Ultimately, the investigators would like to lay the groundwork for developing guidelines that define the ideal induction agent for trauma RSIs. Study population: Adult trauma patients undergoing RSI within 24 hours of hospital admission Methodology: A multicenter, prospective observational study will be performed. Endpoints: In-hospital mortality, 28-day mortality, ICU and total hospital length of stay, complications, hypotension and vasopressor use 30 minutes and 24 hours after intubation, mechanical ventilator days, and discharge disposition Statistic plan: Data will be entered into a password-protected online data collection tool known as RedCap, and analyzed using SAS version 9.4 (SAS Institute, Inc., Cary, NC).
Interventions
DRUGKetamine
Administering ketamine as an induction medication for intubating adult trauma patients within 24 hours of hospital admission.
DRUGEtomidate
Administering etomidate as an induction medication for intubating adult trauma patients within 24 hours of hospital admission.
DRUGPropofol
Administering propofol as an induction medication for intubating adult trauma patients within 24 hours of hospital admission.
Sponsors
University of Southern California
University of California, Irvine
University of Texas
University of Chicago
Medical College of Wisconsin
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Trauma patients \>=18 yo requiring intubation within 24 hours of admission in either the ED or OR * Patients received propofol, etomidate, or ketamine for induction agent
Exclusion criteria
* Patients who were intubated without induction agent medications * Patients intubated outside of the hospital or in the field * Patients who were intubated with an induction agent other than etomidate, ketamine, or propofol
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| in-hospital mortality | through study completion, an average of 1 year | mortality |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| total hospital length of stay | through study completion, an average of 1 year | days |
| intensive care unit length of stay | through study completion, an average of 1 year | days |
| mechanical ventilator days | through study completion, an average of 1 year | days |
| Number of participants with hypotension | 30 minutes after intubation | defined as systolic blood pressure\<90 mmHg or mean arterial pressure \<50 mmHg |
| Number of participants requiring vasopressor use | 30 minutes after intubation | vasopressor use |
| number of complications | through study completion, an average of 1 year | examples: adrenal insufficiency, aspiration, pneumonia, acute respiratory distress syndrome, organ failure, etc. |
| 28-day mortality | 28 days after admission | 28 day mortality |
| discharge disposition | through study completion, an average of 1 year | examples: discharge home no services, home with services, skilled nursing facility, rehabilitation center, etc. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORCatherine M Kuza, MD
Keck School of Medicine of the University of Southern California
Outcome results
None listed