Does the Choice of Ketamine or Thiopentone as the Induction Agent for Rapid Sequence Induction in Trauma Affect Outcomes? A Retrospective Observational Pilot Study

Abstract

Objectives: Injured patients requiring intubation usually undergo rapid sequence induction, which has the potential to exacerbate physiologic instability. This study aimed to identify the physiological characteristics and induction agents of trauma patients intubated in our Emergency Department, and investigate whether the choice of ketamine or thiopentone was associated with better outcomes.Methods: This was a retrospective study of 96 patients identified from the trauma database at a tertiary teaching hospital. Trauma patients intubated in the emergency department with either ketamine or thiopentone were included. We examined the association between the patient’s functional status at hospital discharge or 6 months (whichever was sooner), the induction agent, and other recognized prognostic variables such as Glasgow Coma Score, blood pressure and oxygen saturation.Results: 148 patients were intubated during the study period, 96 of who were eligible for inclusion. 56 were intubated with thiopentone and 40 with ketamine. Fifty percent of patients in each group were eventually discharged from hospital at their baseline level of function. On univariate analysis, survival rates were similar whether induced with ketamine or thiopentone (85% vs. 77%, p = 0.33), as were rates of independent living at discharge (75% vs. 73%, p = 0.82). Systolic blood pressures were lower in the ketamine group (p < 0.01). Increasing age (p < 0.01), reducing GCS (p < 0.01), and an abnormal cerebral CT scan (p = 0.03) were all significantly associated with a poorer outcome.Conclusion: No difference in outcome was seen whether patients were intubated with ketamine or thiopentone in this small retrospective cohort.