A large randomized trial comparing ketamine versus etomidate for emergency intubation in critically ill patients found no significant difference in cardiovascular collapse rates between the two anesthetic agents. The study challenges long-held preferences for etomidate based on its perceived hemodynamic stability. This comparative effectiveness research fills a crucial evidence gap in critical care medicine, where anesthesiologist preferences have historically driven drug selection without robust head-to-head data. The finding suggests ketamine may offer equivalent safety with potential advantages including preserved respiratory drive and reduced adrenal suppression risk. For emergency medicine and intensive care practitioners, this evidence supports expanding ketamine use in hemodynamically unstable patients who previously would have received etomidate by default. However, the study's focus on immediate cardiovascular outcomes leaves questions about longer-term effects and specific patient subgroups who might benefit more from one agent. The research represents a shift toward evidence-based sedation protocols in critical care, moving beyond theoretical pharmacologic advantages to real-world clinical outcomes in high-stakes emergency intubations.