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Ketamine for rapid sequence intubation in adult trauma patients: A retrospective observational study
Author(s) -
Baekgaard Josefine S.,
Eskesen Trine G.,
Moo Lee Jae,
Ikast Ottosen Camilla,
Bennett Gyldenkærne Katrine,
Garoussian Jasmin,
Ejlersgaard Christensen Rasmus,
Sillesen Martin,
King David R.,
Velmahos George C.,
Rasmussen Lars S.,
Steinmetz Jacob
Publication year - 2020
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.13651
Subject(s) - medicine , ketamine , glasgow coma scale , intubation , etomidate , retrospective cohort study , anesthesia , odds ratio , injury severity score , logistic regression , midazolam , population , propofol , surgery , emergency medicine , poison control , injury prevention , sedation , environmental health
Background In the trauma population, ketamine is commonly used during rapid sequence induction. However, as ketamine has been associated with important side effects, this study sought to compare in‐hospital mortality in trauma patients after induction with ketamine versus other induction agents. Methods We retrospectively identified adult trauma patients intubated in the pre‐hospital phase or initially in the trauma bay at two urban level‐1 trauma centers during a 2‐year period using local trauma registries and medical records. In‐hospital mortality was compared for patients intubated with ketamine versus other agents using logistic regression with adjustment for age, gender, Injury Severity Score (ISS), systolic blood pressure (SBP) < 90 mm Hg, and pre‐hospital Glasgow Coma Scale (GCS) score. Results A total of 343 trauma patients were included with a median ISS of 25 [17‐34]. The most frequently used induction agents were ketamine (36%) and propofol (36%) followed by etomidate (9%) and midazolam (5%). There was no difference in ISS or the presence of SBP <90 mm Hg according to the agent of choice, but the pre‐hospital GCS score was higher for patients intubated with ketamine (median 8 vs 5, P = .001). The mortality for patients intubated with ketamine was 18% vs 27% for patients intubated with other agents ( P = .14). This remained statistically insignificant in the multivariable logistic regression analysis (odds ratio 0.68 [0.33‐1.41], P = .30). Conclusions We found no statistically significant difference in mortality among patients intubated in the initial phase post‐trauma with the use of ketamine compared with other agents (propofol, etomidate, or midazolam).