Etomidate and the Risk of Complications After Cardiac Surgery: A Retrospective Cohort Analysis

Abstract

To compare incidence of atrial arrhythmia, duration of care, and major complications after cardiac surgery between patients who received etomidate and those who received other induction agents. Retrospective cohort study utilizing propensity score matching. A single academic, tertiary care hospital. Eight thousand nine hundred seventy-eight patients undergoing coronary artery bypass grafting (CABG), valve, or combined valve/CABG surgery requiring cardiopulmonary bypass between January 2005 and December 2010. Patients were divided into those who received etomidate at anesthetic induction and those who received another induction agent. Patients given etomidate were propensity-score matched to patients given other induction agents in a 2:1 ratio. Of 8,978 patients who underwent CABG, valve, or combined valve/surgery, 6,313 received etomidate and 2,665 received other induction agents. Among these, the authors successfully matched 4,094 etomidate patients with 2,524 non-etomidate patients. The authors did not find a significant association between receiving etomidate and odds of experiencing postoperative atrial arrhythmia (odds ratio [98.3% confidence interval] of 1.07 [0.92, 1.23], p = 0.29). Etomidate was not associated significantly with either intensive care unit or hospital stay. Etomidate was associated significantly with use of packed red blood cells (odds ratio [99.6% confidence interval] of 1.32 [1.02, 1.70], p = 0.002), but not with use of fresh frozen plasma, platelets, or cryoprecipitate. None of the other complications differed significantly between the groups. Etomidate was not associated with increased incidence of postoperative atrial arrhythmia or increased intensive care unit or hospital stay.