ABSTRACTS
Prehospital Ketamine Administration for Trauma Patients Results in More Emergency Department IntubationsAuthor: James Charles | | Associate Authors: Nicholas Taylor, MD, Alison Smith, MD, Lillian Bellfi, James Aiken, James, MD, Lance Stuke, MD, Patrick Greiffenstein, MD, Alan Marr, MD, John Hunt, MD, Jonathan Schoen, MD, Elizabeth Lacy, MHA, NRP
Introduction The use of ketamine in the prehospital setting has become increasingly popular among EMS providers despite the known adverse effects. This study hypothesized that respiratory depression or oversedation from ketamine would increase the number of emergency department (ED) intubations. Objective To evaluate the effects of prehospital ketamine on trauma patients presenting to a Level 1 trauma center. Methods A retrospective chart review of adult trauma patients receiving prehospital ketamine during a 5-year period was performed. A 1:1 propensity match was performed of patients with similar demographics, injury severity, and mechanism of injury who did not receive prehospital ketamine. Univariate analyses were used to compare the groups. The primary outcome was the incidence of intubation in the ED. Results A total of 74 trauma patients who received prehospital ketamine were identified. The average ketamine dose was 39.2 mg IV (±34.5 mg) and 226.4 mg IM (±160.2 mg), with 33.8% of patients receiving ketamine for pain and 28.4% receiving it for agitation. The ED intubation rate was higher in the prehospital ketamine group with 17.6% (n = 13/74) requiring intubation as compared with 4.8% (n = 3/63) who did not receive ketamine (p = 0.03). Patients who required intubation in the ED had higher average doses of both IV/IO (55.0 ± 24.2 mg vs. 37.7 ± 4.8 mg) and IM ketamine (290.0 ± 41.3 mg vs. 196.4 ± 41.7 mg). Conclusions This study demonstrated that patients who were intubated were more likely to receive a high dose of ketamine, more likely to receive IM ketamine, and more likely to receive ketamine for agitation. Further studies are necessary to help refine prehospital protocols studies to allow for more efficacious utilization of prehospital ketamine given its increasing popularity.
|
