Ephedrine versus Ketamine in Preventing Hemodynamic Instability in Intubated and Mechanically Ventilated Patients; An Observational Study

Background: Rapid sequence intubation (RSI) in hemodynamically unstable patients - characterized by tachycardia and hypotension- is critical in the emergency department (ED). The use of vasopressors and sympathomimetics during airway management needs careful consideration. No studies have examined the hemodynamic effects of ephedrine and ketamine in this context. This study aims to compare the efficacy of ephedrine and ketamine in preventing hemodynamic instability in ED patients with systolic blood pressure (SBP) of ≤100 mmHg undergoing intubation-assisted mechanical ventilation. Method: A prospective observational study was conducted involving 50 patients (mean age: 48.15±17.42 years, 52.0% male) requiring mechanical ventilation with an SBP of ≤ 100 mmHg. The patients were randomly assigned to the ephedrine group (30 mg/kg; n=26) and ketamine group (2 mg/kg; n=24). Hemodynamic variables were compared before and after intubation at the 5-minute and 10-minute marks. The intubation conditions were evaluated according to rapid sequence intubation (RSI) protocols. Results: The heart rate exhibited minimal variability between the two groups, with the ephedrine group showing a mean of 110.79 ± 23.89 bpm compared to the ketamine group at 111.19 ± 18.95 bpm, recorded 10 minutes post-intubation. Conversely, there was a notable increase in mean SBP following the administration of both pharmacological agents, with a statistically significant elevation observed in the ketamine group (94.42 ± 12.82 mmHg) compared to the ephedrine group (86.70 ± 12.29 mmHg, p < 0.05) at the 10-minute mark post-intubation. Additionally, mean diastolic blood pressure (DBP) also demonstrated an upward trend in both cohorts’ post-drug administration, with the ephedrine group recording a higher mean DBP of 61.92 ± 9.24 mmHg versus 59.40 ± 8.95 mmHg in the ketamine group (p < 0.0001). Conclusion: Ephedrine administered at 30 mg/kg during the intubation process has enhanced the conditions for successful intubation. The study concluded that ephedrine is more effective than ketamine in mitigating hemodynamic instability in intubated patients receiving mechanical ventilation.