Editor’s Capsule Summary
What is already known on this topic
Although sympathomimetic, ketamine can produce hypotension in patients with depleted catecholamine stores.
What question this study addressed
When ketamine is used for rapid sequence intubation, how do the resulting hemodynamics differ when patients with or without risk of shock are compared (as estimated by the shock index)?
What this study adds to our knowledge
In this observational comparison of 112 out-of-hospital adults, those without apparent shock generally exhibited the expected increases in blood pressure and pulse. These effects were blunted in patients with a high shock index, with 8 of these 31 experiencing hypotension.
How this is relevant to clinical practice
When ketamine is used for rapid sequence induction, hypotension and blunted sympathomimetic responses are more common when initial hemodynamics suggest possible shock.