Use of Etomidate for Rapid Sequence Intubation (RSI) in Pediatric Trauma Patients: An Exploratory National Survey.

Jeffrey Cies,Wayne Moore Ii,Shonola Da-Silva,Arun Chopra,Matthew Moront,Kelsey Gannon,Renata Ostrowicki,Jason Parker

doi:10.3390/pharmacy3040197

Abstract

Objective, To survey the pediatric trauma programs to ascertain if and how etomidate is being used for rapid sequence intubation (RSI) in pediatric trauma patients. Design, A 25 question survey was created using REDCaps. A link to the survey was emailed to each of the pediatric and adult trauma programs that care for pediatric patients. Setting, Pediatric trauma programs and adult trauma programs caring for pediatric patients. Intervention, None. Measurements and Main Results, A total of 16% of programs responded (40/247). 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 (18/40). 33/38 respondents state they use etomidate in their RSI protocol but it is not used in all pediatric trauma patients. 26/38 respondents believe that etomidate is associated with adrenal suppression and 24/37 believe it exacerbates adrenal suppression in pediatric trauma patients yet 28 of 37 respondents do not believe it is clinically relevant. Conclusions, Based on the results of the survey, the use of etomidate in pediatric trauma patients is common among urban, academic, teaching, level 1 pediatric trauma centers. A prospective evaluation of etomidate use for RSI in pediatric trauma patients to evaluate is potential effects on adrenal suppression and hemodynamics is warranted.

Highlights

Pediatric trauma patients are often intubated using rapid sequence intubation (RSI) with an anesthetic and paralytic agent
Twenty-three (23/40, 57.5%) respondents state they provide care for pediatric trauma patients in a separate trauma bay within the emergency department (ED) and the airway is primarily managed by emergency department (ED) personnel (25/39, 64%, 1 non-response) followed by anesthesia (9/39, 23%, 1 non-response) (Table 2)
Twenty-six of 38 (68.4%, two non-responses) respondents believe that etomidate is associated with adrenal suppression and 24 of 37 (64.8%, three non-responses) believe it exacerbates adrenal suppression in pediatric trauma patients

Summary

Introduction

Pediatric trauma patients are often intubated using rapid sequence intubation (RSI) with an anesthetic and paralytic agent. Etomidate is an imidazole-derived ultra-short acting non-barbiturate hypnotic [1]. Potential advantages often cited when using etomidate are rapid onset, lack of significant cardiovascular effects, limited respiratory depression, lack of histamine release, and a short duration of action [1]. Etomidate has been shown to inhibit the 11-beta-hydroxylase enzyme which prevents conversion of deoxycortisol to cortisol in the adrenal gland [2]. This can lead to decreased concentrations of cortisol for up to 48–72 h after administration, sometimes causing profound suppression of cortisol secretion [2]

Results

Discussion

Conclusion