Ketamine Administration Without Coma Induction in the Emergency Setting
Abstract number :
2.233
Submission category :
7. Anti-seizure Medications / 7D. Drug Side Effects
Year :
2021
Submission ID :
1826530
Source :
www.aesnet.org
Presentation date :
12/5/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:55 AM
Authors :
Guneeti Sharma, MS - Massachusetts General Hospital; Megan Barra, PharmD - Department of Pharmacy - Massachusetts General Hospital; James Cloyd, PharmD - Department of Experimental and Clinical Pharmacology - College of Pharmacy and Center for Orphan Drug Research, University of Minnesota; Lisa Coles, PhD - Department of Experimental and Clinical Pharmacology - College of Pharmacy and Center for Orphan Drug Research, University of Minnesota; Can Ozan Tan, PhD - Department of Physical Medicine and Rehabilitation - Spaulding Rehabilitation Hospital; Joshua Goldstein, MD, PhD - Department of Emergency Medicine - Massachusetts General Hospital; Bryan Hayes, PharmD - Department of Pharmacy - Massachusetts General Hospital; Jaideep Kapur, MBBS, PhD - Department of Neurology - University of Virginia; James Chamberlain, MD - Division of Emergency Medicine - Children’s National Medical Center; Robert Silbergleit, MD - Department of Emergency Medicine - University of Michigan; Thomas Bleck, MD - Feinberg School of Medicine, Northwestern University and Rush Medical College; Andrew Cole - Department of Neurology - Massachusetts General Hospital; Eric Rosenthal - Department of Neurology - Massachusetts General Hospital
Rationale: Ketamine has been proposed as an intubation-sparing therapy to terminate established status epilepticus (SE). Because persistent coma is historically considered a treatment failure, we sought to examine ketamine’s effect on neurologic function using time-synchronized electronic health record data to support a protocol development for the treatment of established SE.
Methods: We retrospectively studied adults administered parenteral ketamine bolus in the emergency department (04/2016-05/2020) with Glasgow Coma Scale (GCS) score documented < 24 hours pre- and post-administration. Change in GCS (∆GCS) ≤ 4 hours post-administration and incidence of unintended intubation were evaluated.
Results: 122 patients met inclusion. Indications for ketamine administration included planned intubation (61.5%), agitation (22.1%), and procedural sedation (13.1%). Median age was 55 years [IQR 36, 68]; average dose was 1.3 mg/kg (SD 0.8); and routes were intravenous (86.1%) or intramuscular (13.9%). When administered for indications other than planned intubation (n=47), median post-ketamine ∆GCS was 0 [-1, 2] at 0-1.9 hours (n=13) and 0 [0, 0] at 2.0-3.9 hours (n=14). 15.4% (2/13) of patients experienced a GCS decline ≥ 2 at 0-1.9 hours and 0% at 2-3.9 hours. When administered for planned intubation (n=75), median post-ketamine ∆GCS was -3 [-7, 0] at 0-1.9 hours (n=17) and -7 [-10, -3] at 2.0-3.9 hours (n=31). 64.7% (11/17) experienced a GCS decline ≥ 2 at 0-1.9 hour and 77.4% (24/31) at 2-3.9 hours. No differences were observed when stratifying by dose (≥ 1.5 mg/kg versus < 1.5 mg/kg) or age (≥ 65 versus < 65 years). Unintended intubation occurred in 8.5% (4/47), all unrelated to ketamine adverse effects, attributed instead to inadequate response (n=2), metabolic disarray-induced respiratory depression (n=1), and surgical intervention (n=1).
Anti-seizure Medications