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Thiopental vs. Etomidate for Rapid Sequence Intubation in Aeromedicine

Abstract Introduction: Although there is a general agreement that rapid sequence intubation (RSI) is thepreferred technique for intubation in aeromedical care, several pharamacological regimens have been employed without clear evidence of which is superior. Hypothesis: This study was designed to compare the use of etomidate (ETOM) with that of thiopental (THIO)as an adjunctive agent used with succinylcholine (SCh) for rapid sequence intubation in an urban, aeromedicalsystem. Methods: This was a retrospective, before-and-after study utilizing computer-assisted chart review. Adultpatients who received thiopental for rapid sequence intubation over a two-year period were compared to adult patients who received etomidate for rapid sequence intubation over a similar period, after a change in protocol, which mandated etomidate rather than thiopental for all intubations. Results: No difference was found in any of the primary endpoints. Stabilization time (13.1 vs. 12.9 minutes), number of intubation attempts (1.1 vs. 1.2), successful first intubation attempts (90% vs. 82%), overallsuccessful intubations (100% vs. 96%), and intubation time (18.4 vs. 21.7 seconds) were similar for all comparisons of thiopental vs. etomidate (all p >0.05). Conclusion: This study found no clinically relevant differences between the use of etomidate or thiopental as adjuncts with succinylcholine for rapid sequence intubation in the aeromedical setting.