941

Abstract

Introduction: Etomidate is an imidazole-derived, ultra-short acting nonbarbiturate hypnotic and has been commonly used as an induction agent in trauma and non-trauma patients. However, etomidate has been shown to inhibit 11-beta-hydroxylase which catalyzes the conversion of deoxycortisol to cortisol in the adrenal gland leading to decreased concentrations of cortisol for up to 48 hours after its administration. The use of etomidate has been associated with an increased morbidity and mortality in many different settings, including pediatrics.. The purpose of this study is to use a questionnaire to determine the following among pediatric trauma programs; a) how common the use of etomidate is for RSI b) determine how pediatric trauma centers are using etomidate, and c) determine why pediatric trauma programs are using etomidate for RSI. Methods: A 25 question survey was created using Survey Monkey, an online survey tool. A link to the survey was emailed to each of the Pediatric and Adult trauma programs that care for pediatric patients. Two additional emails will be sent at 3 months and 5.5 months with reminders to complete the online survey. After 6 months the survey link will be de-activated and the information will be removed from the internet/website for analysis purposes. Currently, the survey has been open for 2 months. The answers to the questions will be analyzed using non-parametric methodology. The significance level, determined a- priori, was set at an α = 0.05. Results: A total of 36 responses have been received. The majority of the centers that responded are urban, academic, teaching Level 1 pediatric trauma centers that provide care for > 200 pediatric trauma patients annually. The trauma program directors were the most likely to respond to the survey (16/36). 30/34 respondents state they use etomidate in their RSI protocol but it is not used in all pediatric trauma patients. 24/34 respondents believe that etomidate is associated with adrenal suppression and 22/33 believe it exacerbates adrenal suppression in pediatric trauma patients yet 24 of 33 respondents do not believe it is clinically relevant. Conclusions: Despite an association with adrenal suppression and effects on morbidity and mortality, the use of etomidate in pediatric trauma patients is common among urban, academic, teaching Level 1 pediatric trauma centers.