Is Prehospital Ketamine Associated With a Change in the Prognosis of PTSD?

Abstract

Introduction Ketamine is an alternative to opioids for prehospital analgesia following serious combat injury. Limited research has examined prehospital ketamine use, associated injuries including traumatic brain injury (TBI) and PTSD outcomes following serious combat injury. Materials and Methods We randomly selected 398 U.S. service members from the Expeditionary Medical Encounter Database who sustained serious combat injuries in Iraq and Afghanistan, 2010-2013. Of these 398 patients, 213 individuals had charted prehospital medications. Clinicians reviewed casualty records to identify injuries and all medications administered. Outcomes were PTSD diagnoses during the first year and during the first 2 years postinjury extracted from military health databases. We compared PTSD outcomes for patients treated with either (a) prehospital ketamine (with or without opioids) or (b) prehospital opioids (without ketamine). Results Fewer patients received prehospital ketamine (26%, 56 of 213) than only prehospital opioids (69%, 146 of 213) (5%, 11 of 213 received neither ketamine nor opioids). The ketamine group averaged significantly more moderate-to-serious injuries, particularly lower limb amputations and open wounds, compared with the opioid group (Ps < .05). Multivariable regressions showed a significant interaction between prehospital ketamine (versus opioids) and TBI on first-year PTSD (P = .027). In subsequent comparisons, the prehospital ketamine group had significantly lower odds of first-year PTSD (OR = 0.08, 95% CI [0.01, 0.71], P = .023) versus prehospital opioids only among patients who did not sustain TBI. We also report results from separate analyses of PTSD outcomes among patients treated with different prehospital opioids only (without ketamine), either morphine or fentanyl. Conclusions The present results showed that patients treated with prehospital ketamine had significantly lower odds of PTSD during the first year postinjury only among patients who did not sustain TBI. These findings can inform combat casualty care guidelines for use of prehospital ketamine and opioid analgesics following serious combat injury.

The potential of ketamine for posttraumatic stress disorder: a review of clinical evidence

“…See Figure 3 for routes of administration. Two chart reviews 72 , 74 combined approaches (IM-IV, 4%; IN-IV, 4%). Of import, all open-label and randomized trials employed ketamine infusions, delivered at 0.5 mg/kg over 40 min, apart from one study 77 administering high-dose ketamine (0.83–4.13 mg/kg) infused over 1 h. With IV administration used most consistently, there is great prospect for replicability in future work to identify standard approaches that maximize patient benefit.…”

“…See Figure 3 for routes of administration. Two chart reviews 72,74 combined approaches (IM-IV, 4%; IN-IV, 4%). Of import, recruiting or recently completed -testing three-tosix serial treatments of ketamine for PTSD.…”

“…Along the same accord, Melcer et al 72 examined correlates of pre-hospital ketamine and PTSD prognosis. They randomly sampled military personnel ( N = 398, M age = 25.1, female = 2%) from the Expeditionary Medical Encounter Database, who sustained serious combat injury in Iraq or Afghanistan.…”

Traumatic brain injury-induced fear generalization in mice involves hippocampal memory trace dysfunction and is alleviated by (R,S)-ketamine

“…No reuse allowed without permission. cross the BBB because of its lipophilic nature [51]. There are few clinical studies investigating the efficacy of (R,S)-ketamine on fear behavior following TBI, as most studies were focused on successfully dispelling the myth that it increased intracranial pressure [52].…”

“…One of the major challenges in developing therapeutics for TBI is overcoming the blood-brain barrier (BBB) while delivering drugs [50]. However, ( R,S )-ketamine is known to effectively cross the BBB because of its lipophilic nature [51]. There are few clinical studies investigating the efficacy of ( R,S )-ketamine on fear behavior following TBI, as most studies were focused on successfully dispelling the myth that it increased intracranial pressure [52].…”