Presenter(s) and Chair: Morad Shaaban and Duncan Bootland / Codes: / Published: 24/02/2026
Summary
Dr Morad Shaaban presented a detailed overview of the RSI trial, a randomised controlled trial comparing ketamine and etomidate as induction agents for intubation. The trial, published in the New England Journal of Medicine, included 2,365 critically ill patients across 14 sites in the United States. While the primary outcome of 28-day mortality showed no significant difference between the two groups, the secondary outcome of hemodynamic collapse within two minutes of intubation favoured etomidate, challenging the perception of ketamine as a hemodynamically stable drug.
Key Learning Points
1. Pragmatic trial design reflects real-world conditions and therefore improves the external validity of the trial results
2. Confidence intervals give an idea of both clinical significance and statistical significance
3. The RSI trial found greater cardiovascular collapse in the ketamine group than the etomidate group as a secondary outcome. Secondary outcomes are hypothesis-generating and do not consider type 1 and type 2 errors.
Original Journal Article Title: Ketamine or Etomidate for Tracheal Intubation of Critically Ill Adults
Original Journal Article Reference: https://www.nejm.org/doi/full/10.1056/NEJMoa2511420
