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A prospective review of the use of ketamine to facilitate endotracheal intubation in the helicopter emergency medical services (HEMS) setting
  1. A Sibley1,2,
  2. M Mackenzie1,2,
  3. J Bawden2,
  4. D Anstett2,
  5. C Villa-Roel2,
  6. B H Rowe2
  1. 1Alberta Shock Trauma Air Rescue Society (STARS), Edmonton, Alberta, Canada
  2. 2Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
  1. Correspondence to Aaron Sibley, Associate Medical Director, Edmonton Zone EMS, Alberta Health Services, Edmonton, AB, Apt 506, 9837-110 Street, Edmonton, Alberta, Canada T5K 2L8; asibley{at}ualberta.ca

Abstract

Introduction Ketamine is a dissociative agent used for sedation and intubation in various clinical settings. Despite its proven haemodynamic safety, ketamine has not been widely used in prehospital medicine. This study examined the use of ketamine in helicopter emergency medical services (HEMS).

Methods This prospective cohort study enrolled all patients transported by a single HEMS program in whom ketamine was used to facilitate intubation. Data were collected using standard forms by two independent trained research staff. Demographics, medical condition, intubation conditions, vital signs (pre and post drug administration) and complications were recorded. Proportions, medians with IQR, change scores and CIs are reported; differences were compared using paired t tests.

Results During the 2-year study period, 71 patients received ketamine to facilitate endotracheal intubation. Ketamine was used most often in men (52 (73%)), and the median age was 49 years (IQR: 31, 69). Most patients were adults (70 (99%)) with medical illnesses (42 (59%)); 37 (52%) intubations were performed at the sending hospital, and 30 (42%) were performed on scene. A paramedic performed the intubation in 58 cases (82%). The median ketamine dose was 80 mg (IQR: 60, 100; ∼1 mg/kg); 53 (75%) patients also received a paralytic agent. Mean arterial pressure (2.3 mmHg; 95% CI: −8.0 to 3.3) and heart rate (0.45 beats/min, 95% CI: −4.9 to 4.0) changes failed to reach statistical or clinical significance. No differences were found between patients with suspected concomitant head injury and other patients with respect to ketamine dose, changes in vital signs and complications. Complications included: one (1.4%) interstitial IV, five (7%) failed intubations, five (7%) hypotension and four (6%) hypertension episodes, one (1%) bradycardia, two (3%) tachycardia and five (7%) deaths.

Conclusions Ketamine is an effective agent in facilitating intubation in a HEMS environment. Complications are similar to use in the controlled Emergency Department setting.

  • Intubation
  • Ketamine
  • prehospital
  • air medical transport
  • HEMS
  • airway
  • nursing
  • pre-hospital
  • paramedics
  • prehospital care
  • critical care transport
  • prehospital care
  • helicopter retrieval

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Footnotes

  • Presentations: The results of this research were presented at the Canadian Association of Emergency Physicians (CAEP) Annual Scientific Meeting, 3–6 June 2009 in Calgary, AB and the National Association of EMS Physicians (NAEMSP) annual conference 7–9 January 2010 in Phoenix, AZ.

  • Competing interests None.

  • Ethics approval Administrative approval was obtained from STARS prior to the beginning of the study. The protocol for this study was approved by the University of Alberta Health Research Ethics Board Panel B.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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