Thiopental vs. Etomidate for Rapid Sequence Intubation in Aeromedicine

INTRODUCTION: Although there is a general agreement that rapid sequence intubation (RSI) is the preferred 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 RSI in an urban, aeromedical system. METHODS: This was a retrospective, before-and-after study utilizing computer-assisted chart review. Adult patients who received THIO for RSI over a two-year period were compared to adult patients who received ETOM for RSI over a similar period, after a change in protocol, which mandated ETOM rather than THIO 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%), overall successful intubations (100% vs. 96%), and intubation time (18.4 vs. 21.7 seconds) were similar for all comparisons of THIO vs. ETOM (all p > 0.05). CONCLUSION: This study found no clinically relevant differences between the use of ETOM or THIO as adjuncts with SCh for RSI in the aeromedical setting.