Ketamine reduces the need for intubation in patients with acute severe mental illness and agitation requiring transport to definitive care: An observational study

Parsch, Cathrin S.; Boonstra, Adrianne; Teubner, David; Emmerton, Wade; McKenny, Brian; Ellis, Daniel Y

doi:10.1111/1742-6723.12763

Cited by 17 publications

(12 citation statements)

References 14 publications

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“…A more recent study by Parsch et al ., undertaken over a similar period of time as the present study, found that the introduction of a ketamine sedation guideline increased the use of ketamine for sedation while decreasing the requirement for intubation of the acutely agitated mental health patient and with a low complication rate . Again, this retrospective cohort study was limited to patients with a diagnosed mental health illness.…”

Section: Introductionmentioning

confidence: 70%

Impact of a ketamine sedation protocol on intubation rates and undesirable outcomes in the transport of patients with acute behavioural disturbance

Shahtahmasebi

Johnson

Shahtahmasebi³

2019

Emerg Medicine Australasia

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Objectives To identify the effects of the introduction of a ketamine sedation protocol on the rates of intubation and adverse events associated with retrieval of patients with acute behavioural disturbance. Transport of patients with acute behavioural disturbance poses clinical and logistical management difficulties, as well as risks. Remote Australian communities are separated by vast distances. Risks to aircraft and crew, and patient and community must be balanced. Ketamine has received increasing attention in recent years for pre‐hospital sedation of behaviourally disturbed patients, predominantly with psychiatric illness. This paper explores the benefits and suitability of ketamine in undifferentiated presentations, using data from the retrieval service in Alice Springs, Australia. Methods A pre‐ and post‐intervention study was carried out. The intervention was the introduction of a ketamine sedation protocol. Pre‐intervention data was collected retrospectively, pre‐2015 and post‐intervention data prospectively from 2015 onwards. Prospective data, rather than only including confirmed psychiatric cases as in previously published series, will provide a powerful message for pre‐hospital and retrieval practice. Group variables were created to compare the incidence of adverse events. Results The introduction of a ketamine protocol significantly reduced rates of intubation. The incidence of adverse events was strongly associated with the method of sedation (P = 0.000, confidence interval −0.56, −0.22), with significantly lower rates with ketamine (P < 0.0001). Conclusion The introduction of a ketamine protocol is associated with a decrease in intubation, and accordingly, a decrease in adverse events, though it is not without its risks. Further analysis is required to establish the likely cost saving to health systems.

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Section: Introductionmentioning

confidence: 70%

Impact of a ketamine sedation protocol on intubation rates and undesirable outcomes in the transport of patients with acute behavioural disturbance

Shahtahmasebi

Johnson

Shahtahmasebi³

2019

Emerg Medicine Australasia

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“…More recently, a 5‐year retrospective chart review sought to observe sedation agents chosen and incidence of adverse events before and after implementation of a ketamine guideline . A total of 78 patients were included, with 34 receiving ketamine for sedation (either alone or in combination with other medications) over the 5‐year period (34 [43.5%]).…”

Section: Literature Reviewmentioning

confidence: 99%

“…More recently, a 5-year retrospective chart review sought to observe sedation agents chosen and incidence of adverse events before and after implementation of a ketamine guideline. 26 A total of 78 patients were included, with 34 receiving ketamine for sedation (either alone or in combination with other medications) over the 5-year period (34 [43.5%]). To be included, patients had to have a mental health history and require transportation for a psychiatric evaluation but could not be requiring transport secondary to a medical emergency (e.g., intended overdose or injury related to suicidal behavior).…”

Section: Miscellaneous Ketamine Studiesmentioning

confidence: 99%

Ketamine for the Acute Management of Excited Delirium and Agitation in the Prehospital Setting

2017

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Traditional first-line therapy in the prehospital setting for the acutely agitated patient includes an antipsychotic in combination with a benzodiazepine. Recently, interest has grown regarding the use of ketamine in the prehospital setting as an attempt to overcome the limitations of the traditional medications and provide a more safe and effective therapy. This review provides an overview of the pharmacology of ketamine, evaluates the literature regarding ketamine use for prehospital agitation, and proposes an algorithm that may be used within the prehospital setting. A literature review was conducted to identify articles utilizing ketamine in the prehospital setting. The review was limited to English-language articles identified in Embase (1988-June 2017) and the U.S. National Library of Medicine (1970-June 2017. References of all pertinent articles were also reviewed. Ten articles were identified including 418 patients receiving ketamine for agitation. The most commonly utilized route for administration was intramuscular (IM), with five of the seven IM administration studies using a ketamine dose of 5 mg/kg. Ketamine administered in this fashion was efficacious to achieve proper sedation during transport and did not require repeat dosing. Three studies applied a ketamine protocol to outline dosing and the management of ketamine adverse events. The most common adverse events identified were respiratory-related events and hypersalivation. Ketamine has a role for agitation management in the prehospital setting; however, emergency personnel education and ketamine protocols should be utilized to aid in safe and effective pharmacotherapy and provide guidance on the management of adverse events. Future prospective comparative studies, with protocolized standard ketamine regimens, are needed to further delineate the role of ketamine in agitation management and identify accurate adverse event incidence rates.

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“…Acute agitation is characterised as high anxiety, restlessness and aggression, and can result in delirium, cardiac arrest and death . Undifferentiated agitation may be because of alcohol or drug intoxication, psychiatric illness or underlying medical conditions . In medical emergencies involving aggressive patients, paramedics and police are often the first responders, although the prevalence of acute agitation in the pre‐hospital setting is unknown.…”

Section: Introductionmentioning

confidence: 99%

“…For example, conventional sedating agents include antipsychotics and benzodiazepines, although ketamine is becoming more widely used for its rapid onset and dissociative effect despite some studies reporting increased intubations . While some ambulance services have conducted internal evaluations of management regimes such as sedating agents, these do not capture the breadth of practices across services to make direct comparisons. Similar evaluations in the ED and psychiatric settings have provided important insights into areas for further research.…”

Section: Introductionmentioning

confidence: 99%

Variations in the care of agitated patients in Australia and New Zealand ambulance services

Nambiar

Pearce²,

Bray

et al. 2019

Emerg Medicine Australasia

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Ketamine reduces the need for intubation in patients with acute severe mental illness and agitation requiring transport to definitive care: An observational study

Cited by 17 publications

References 14 publications

Impact of a ketamine sedation protocol on intubation rates and undesirable outcomes in the transport of patients with acute behavioural disturbance

Impact of a ketamine sedation protocol on intubation rates and undesirable outcomes in the transport of patients with acute behavioural disturbance

Ketamine for the Acute Management of Excited Delirium and Agitation in the Prehospital Setting

Variations in the care of agitated patients in Australia and New Zealand ambulance services

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