Outcomes Associated with Lower Doses of Ketamine by Emergency Medical Services for Profound Agitation

Introduction: Ketamine is commonly used to treat profound agitation in the prehospital setting. Early in ketamine’s prehospital use, intubation after arrival in the emergency department (ED) was frequent. We sought to measure the frequency of ED intubation at a Midwest academic medical center after...

Full description

Saved in:
Bibliographic Details
Published in:The western journal of emergency medicine 2021-09, Vol.22 (5), p.1183-1189
Main Authors: Coffey, Shaila, Vakkalanka, J. Priyanka, Egan, Haley, Wallace, Kelli, Harland, Karisa, Mohr, Nicholas, Ahmed, Azeemuddin
Format: Article
Language:English
Subjects:
Anesthesia
Benzodiazepines
Blood pressure
Confidence intervals
Drug dosages
Electronic health records
Emergency medical care
Emergency Medical Services
Emergency services
Epidemiology
Hypertension
Intubation
Ketamine
Medical records
Medicine
Patients
Population
Respiratory failure
Trauma
Trauma centers
Vital signs
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Introduction: Ketamine is commonly used to treat profound agitation in the prehospital setting. Early in ketamine’s prehospital use, intubation after arrival in the emergency department (ED) was frequent. We sought to measure the frequency of ED intubation at a Midwest academic medical center after prehospital ketamine use for profound agitation, hypothesizing that intubation has become less frequent as prehospital ketamine has become more common and prehospital dosing has improved. Methods: We conducted a retrospective cohort study of adult patients receiving ketamine in the prehospital setting for profound agitation and transported to a midwestern, 60,000-visit, Level 1 trauma center between January 1, 2017–- March 1, 2021. We report descriptive analyses of patient-level prehospital clinical data and ED outcomes. The primary outcome was proportion of patients intubated in the ED. Results: A total of 78 patients received ketamine in the prehospital setting (69% male, mean age 36 years). Of the 42 (54%) admitted patients, 15 (36% of admissions) were admissions to the intensive care unit. Overall, 12% (95% confidence interval [CI]), 4.5-18.6%)] of patients were intubated, and indications included agitation (n = 4), airway protection not otherwise specified (n = 4), and respiratory failure (n = 1). Conclusion: Endotracheal intubation in the ED after prehospital ketamine use for profound agitation in our study sample was found to be less than previously reported.
ISSN:1936-900X
1936-9018
1936-9018
DOI:10.5811/westjem.2021.5.50845