Cross-sectional analysis of ketamine use in a large urban/suburban area
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Abstract
Objective: Ketamine use is increasing across the US with 33% of EMS protocols authorizing use in 2018. This study evaluates the ketamine use in single large urban/suburban fire-based EMS system.
Methods: Prehospital electronic medical records from 1/2021 to 12/2021 were queried for ketamine use. Data included: date, time, unit number, dose, route, and primary impression. Patients were grouped as low-dose or high-dose ketamine. Low-dose ketamine was defined as 0.2mg/kg intravenous (IV), intramuscular (IM), or intraosseous (IO) for adjunct pain control or severe respiratory distress. High-dose ketamine was defined as ≥2mg/kg IV/IO/IM for severe pain, severe burns, excited delirium, post-intubation sedation, or presumed asthma induced cardiac arrest. Since patient weight was unavailable, we considered 60mg or less of ketamine as low-dose, and over 60mg as high-dose. Descriptive and temporal statistics, chi square, and t-test were used.
Results: 711 total records of ketamine use were obtained. 19 were excluded due to missing dosage. 576 patients received 692 doses of ketamine (108 patients received 2 doses and 8 patients 3 doses). Low-dose ketamine was administered to 102 patients (23 IM, 79 Vascular). High-dose ketamine was administered to 474 patients (343 IM, 129 Vascular, 1 each of endotracheal and intranasal). Average first dose for low-dose ketamine was 27.57mg +/- 12.57mg with median 25mg (IQR 20mg-30mg, nonnormal distribution). Average first dose for high-dose ketamine was 223.03mg +/- 91.98 mg with median 200mg (IQR 200mg-300mg). Ketamine use was not statistically different for day of the week. Peak daily ketamine use was from 1600-2000 hrs. and lowest use was 0600-0800 hrs.
Conclusions: The majority of patients were given high-dose ketamine for severe pain and/or sedation. Low-dose ketamine was mainly IV while high-dose ketamine was predominantly IM. Our study is limited by not having patient’s weight to determine dosage by mg/kg or follow up data to analyze outcome.
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