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Ketamine for Pharmacological Management of Aggression and Agitation in Pre-Hospital Settings: A Review of Comparative Clinical Effectiveness, Safety and Guidelines

Last updated: May 13, 2019
Project Number: RC1118-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the comparative evidence regarding safety of ketamine administration performed in pre-hospital settings versus by a physician for pharmacological management of aggression and agitation?
  2. What is the comparative safety between ketamine and lorazepam, diazepam, or haloperidol for pharmacological management of aggression and agitation in pre-hospital settings?
  3. What is the comparative clinical effectiveness and safety between ketamine and lorazepam, diazepam, or haloperidol for pharmacological management of aggression and agitation in any setting?
  4. What are the evidence-based guidelines regarding the pharmacological management of aggression and agitation in pre-hospital settings?

Key Message

Low quality evidence suggests that ketamine was associated with higher intubation rate when administered by ground emergency medical services paramedics compared with services during air medical transport or services at the emergency department. In prehospital settings (i.e., care by paramedics), ketamine was associated with higher rate of intubation and frequency of complications compared with haloperidol plus benzodiazepine or haloperidol alone. In the emergency department setting, ketamine administration resulted in significantly faster sedation, but no significant difference in intubation rate compared with other pharmacological sedation. No studies conducted in the community health centre, or remote and isolated care facilities settings, where ketamine was given in the absence of a physician, were identified. No evidence-based guidelines were identified regarding the pharmacological management of aggression and agitation in prehospital settings.