Mike et al,  

I am aware that it is controversial since the mortality amongst study participant's may have been related to the underlying severity of illness. 

Proving a cause effect relationship will be challenging, to say the least. However, if you review a more recent metaanalysis from the critical care literature, the association between etomidate for RSI & all cause mortality, as well as blunting of adrenal response to an ACTH stimulation test, although small, appears to be real. [RR of death 1.20; 95% CI 1.02-1.42; RR for adrenal insufficiency 1.33; 95% CI 1.22-1.46] 

Etomidate is associated with mortality and adrenal insufficiency in sepsis: a meta-analysis*. Chan CM, Mitchell AL, Shorr AF. Crit Care Med. 2012 Nov;40(11):2945-53. 

Since we have other sedatives drugs in our quiver, my practice off late has been to avoid Etomidate in the severely ill or injured patients. Would love to hear from others as well as more details of your EM JC discussion. 

BTW, "ketamine" myth has been "debunked"!


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