Etomidate Versus Midazolam for Out-of-Hospital Intubation: A Prospective, Randomized Trial
Presented as a poster at the American College of Emergency Physicians Research Forum, October 2003, Boston, MA.
Received 1 September 2005; received in revised form 18 November 2005 and 2 December 2005; accepted 9 December 2005. published online 08 February 2006.
Refers to article:
Out-of-Hospital Endotracheal Intubation: Half Empty or Half Full?
, 27 February 2006
John H. Burton
Annals of Emergency Medicine
June 2006 (Vol. 47, Issue 6, Pages 542-544) Full Text |
Full-Text PDF (69 KB)
Study objective
The primary objective of this study is to compare the intubation success rates of etomidate and midazolam when used for sedative-facilitated intubation, without paralytics, in out-of-hospital adult patients.
Methods
This prospective, double-blind, randomized trial was conducted with 2 ground out-of-hospital advanced life support systems (ALS); all patients aged 18 or older who required out-of-hospital sedative-facilitated intubation were eligible for participation. The ambulances were stocked with blinded numbered syringes containing either 7 mg of midazolam or 20 mg of etomidate. No paralytics were used. If sedation was not achieved with the study drug, medics could request additional sedation from a medical command physician; only midazolam or diazepam were available outside of the study.
Results
One hundred ten patients were enrolled in the study; 55 patients received midazolam and 55 patients received etomidate. The 2 groups were similar with regard to age, sex, initial vital signs, and reasons for intubation or sedation. The overall intubation success rate was 76% (95% confidence interval [CI] 68% to 84%); 75% (41/55) for midazolam (95% CI 64% to 86%) and 76% (42/55) for etomidate (95% CI 65% to 87%). There was also no difference in incidence of hypotension, number of intubation attempts, or perceived difficulty of intubation. Additional sedation was requested almost equally for the 2 groups: 14 patients in the midazolam group and 12 patients in the etomidate group. A benzodiazepine was successful for rescue of a failed etomidate intubation 10 of 12 times (83%; 95% CI 62% to 100%). When used for rescue of failed midazolam intubations, benzodiazepines were effective in only 5 of 14 (36%, 95% CI 11% to 61%) attempts.
Conclusion
There were no observed differences between midazolam and etomidate in sedation-facilitated intubation success rates; we could not fully evaluate global outcomes of these agents or the sedative-facilitated intubation strategy itself.
aEmergency Medicine Residency, St. Luke’s Hospital, Bethlehem, PA
Address for correspondence: Jeanne Jacoby, MD, Emergency Medicine Residency, St. Luke’s Hospital, 801 Ostrum Street, Bethlehem, PA 18015; 610-954-4903, fax 610-954-2153
Supervising editor: Donald M. Yealy, MD
Author contributions: JJ, MH, JN conceived the study and designed the trial. JJ, GS, JM supervised the conduct of the trial and data collection. JR provided statistical advice on study design and analyzed the data and performed interim analysis. MC, JJ, GS, JN were responsible for paramedic teaching and field implementation. NP performed data collection and formatting (pre-hospital). SJ performed data collection and formatting (follow-up). JJ and MH drafted the manuscript. JJ takes responsibility for the paper as a whole.
Funding and support: The authors report this study did not receive any outside funding or support.
ABSTRACT