A prospective study of ketamine as primary therapy for prehospital profound agitation

Cole, Jon B.; Klein, Lauren R.; Nystrom, Paul C.; Moore, Johanna C.; Fryza, Brandon J.; Harrington, Justin; Ho, Jeffrey D.

doi:10.1016/j.ajem.2017.10.022

Cited by 60 publications

(36 citation statements)

References 36 publications

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“…In contrast, Cole et al's single-center studies reported that intubation rates were 39% in severely agitated patients and 57% in profoundly agitated patients who received ketamine 5 mg/kg IM in the prehospital setting. [13][14] These studies raised concern about the safety of ketamine use. The differences in intubation rates between our study and Cole et al's studies may be attributed to a number of factors.…”

Section: Discussionmentioning

confidence: 99%

“…studied for severe agitation/excited delirium in the prehospital setting. [12][13][14] Ketamine use for this indication has also been studied in a limited number of patients in single-center EDs. 15,16 Adequate sedation is necessary to prevent severe agitation/excited delirium complications such as metabolic abnormalities, cardiac arrest, and death.…”

Section: How Does This Improve Population Health?mentioning

confidence: 99%

“…13 These authors also reported intubation rates of 57% in profoundly agitated patients who received ketamine in the prehospital setting. 14 SDDK use may also lead to neuropsychiatric adverse events such as mood changes, dysphoria, confusion, and hallucinations. [4][5][6]16 To assist emergency medicine (EM) prescribers in safely using ketamine, our emergency services attending physicians and pharmacists developed two ED ketamine protocols for these two indications.…”

Section: How Does This Improve Population Health?mentioning

confidence: 99%

“…[8][9][17][18] Additionally, limited, single-center studies have assessed the safety of IM ketamine for severe agitation/excited delirium in the prehospital setting and ED. [12][13][14][15][16] We designed this multicenter study to provide further insight into the safety of ketamine use in the ED for these two novel indications across a broad spectrum of EDs in a variety of settings.…”

Section: How Does This Improve Population Health?mentioning

confidence: 99%

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Ketamine Safety and Use in the Emergency Department for Pain and Agitation/Delirium: A Health System Experience

Campbell

Fertel

et al. 2020

WestJEM

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Introduction: Two protocols were developed to guide the use of subdissociative dose ketamine (SDDK) for analgesia and dissociative sedation ketamine for severe agitation/excited delirium in the emergency department (ED). We sought to evaluate the safety of these protocols implemented in 18 EDs within a large health system. Methods: We conducted a retrospective chart review to evaluate all adult patients who received intravenous (IV) SDDK for analgesia and intramuscular (IM) dissociative sedation ketamine for severe agitation/excited delirium in 12 hospital-based and six freestanding EDs over a one-year period from the protocol implementation. We developed a standardized data collection form and used it to record patient information regarding ketamine use, concomitant medication use, and any comorbidities that could have impacted the incidence of adverse events. Results: Approximately 570,000 ED visits occurred during the study period. SDDK was used in 210 ED encounters, while dissociative sedation ketamine for severe agitation/excited delirium was used in 37 ED encounters. SDDK was used in 83% (15/18) of sites while dissociative sedation ketamine was used in 50% (9/18) of sites. Endotracheal intubation, non-rebreather mask, and nasal cannula ≥ four liters per minute were identified in one, five, and three patients, respectively. Neuropsychiatric adverse events were identified in 4% (9/210) of patients who received SDDK. Conclusion: Patients experienced limited neuropsychiatric adverse events from SDDK. Additionally, dissociative sedation ketamine for severe agitation/excited delirium led to less endotracheal intubation than reported in the prehospital literature. The favorable safety profile of ketamine use in the ED may prompt further increases in usage.

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Section: Discussionmentioning

confidence: 99%

Section: How Does This Improve Population Health?mentioning

confidence: 99%

Section: How Does This Improve Population Health?mentioning

confidence: 99%

Section: How Does This Improve Population Health?mentioning

confidence: 99%

See 2 more Smart Citations

Ketamine Safety and Use in the Emergency Department for Pain and Agitation/Delirium: A Health System Experience

Campbell

Fertel

et al. 2020

WestJEM

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“…There are no universally accepted treatment strategies for these patients. Many treatment strategies are regionalized, such as ketamine use for acute out‐of‐hospital agitation , which is frequently administered in the US Midwest but is infrequently used in other areas . As NPS compounds are often present in a community for a distinct time‐period, the effectiveness and safety of these treatments may vary as the compounds transition in a region.…”

Section: Introductionmentioning

confidence: 99%

The Psychoactive Surveillance Consortium and Analysis Network (PSCAN): the first year

et al. 2019

Self Cite

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Background and aims The Psychoactive Surveillance Consortium and Analysis Network (PSCAN) is a national network of academic emergency departments (ED), analytical toxicologists and pharmacologists that collects clinical data paired with biological samples to identify and improve treatments of medical conditions arising from use of new psychoactive substances (NPS). The aim of this study was to gather clinical data with paired drug identification from NPS users who presented to EDs within PSCAN during its first year . Design Observational study involving patient records and biological samples. Setting Seven academic emergency medical centers across the United States. Participants ED patients (n = 127) > 8 years of age with possible NPS use who were identified and enrolled in PSCAN by clinical providers or research personnel. Measurements Clinical signs, symptoms and treatments were abstracted from the patients' health records. Biological samples were collected from leftover urine, serum and whole blood. Biological and drug samples, when available, were tested for drugs and drug metabolites via liquid chromatography-quadrupole time-of-flight mass spectrometry (LC-QTOF/MS). Findings Patients in whom synthetic opioids were detected (n = 9) showed higher rates of intubation (four of nine), impaired mental status (four of nine) and respiratory acidosis (five of nine) compared with the rest of the cohort (nine of 118, P-value < 0.05). Patients in whom synthetic cannabinoid (SC) were found (n = 27) had lower median diastolic blood pressures (70.5 versus 77 mmHg, P = 0.046) compared with the rest of the cohort. In 64 cases of single drug ingestion, benzodiazepines were administered in 25 cases and considered effective by the treating physician in 21 (84%) cases. Conclusions During its first year of operation, the Psychoactive Surveillance Consortium and Analysis Network captured clinical data on new classes of drugs paired with biological samples over a large geographical area in the United States. Synthetic cannabinoids were the most common new psychoactive drug identified. Synthetic opioids were associated with a high rate of intubation and respiratory acidosis.

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Behavioral health emergencies

Reich¹,

Ng²

2021

Emergency Medical Services

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A prospective study of ketamine as primary therapy for prehospital profound agitation

Cited by 60 publications

References 36 publications

Ketamine Safety and Use in the Emergency Department for Pain and Agitation/Delirium: A Health System Experience

Ketamine Safety and Use in the Emergency Department for Pain and Agitation/Delirium: A Health System Experience

The Psychoactive Surveillance Consortium and Analysis Network (PSCAN): the first year

Behavioral health emergencies

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