How Safe Is Ketamine For Sedation in the ER? Interview with:
Lindsay Cohen MD
Department of Emergency Medicine
University of British Columbia

Medical Research: What are the main findings of the study?

Dr. Cohen: In our systematic review of the literature, we sought to synthesize the available evidence on the effect of ketamine on clinical outcomes as compared to other sedative agents in intubated patients. Our outcomes of interest included intracranial and cerebral perfusion pressures, neurologic outcomes, ICU length of stay, and mortality. We included only randomized controlled trials and prospective controlled studies, and identified a total of ten studies that met our inclusion criteria. Due to the lack of homogeneity in the studies, data was analyzed in a qualitative manner. None of the studies reported significant differences between ketamine and other sedative agents for any of our outcomes of interest.

Medical Research: What should clinicians take away from this study?

Dr. Cohen: Emergency departments see a high volume of undifferentiated critically ill patients who require imminent airway management before investigations to rule out neurological injuries have been completed. Emergency physicians’ historical reluctance to use ketamine in this population is based on case reports and case control studies published over forty years ago, based on observations in patients with pre-existing intracranial pathology. Our systematic review finds no evidence to preclude the use of ketamine in the undifferentiated emergency department patient. This is particularly relevant given the favourable hemodynamic profile of ketamine, and the lack of other induction agents with similar hemodynamic profiles.

Medical Research: Directions for future research?

Dr. Cohen: Our study is limited by the lack of large, well-designed, randomized controlled trials addressing this topic; additional studies of this nature are needed to more definitively answer this question.

The Effect of Ketamine on Intracranial and Cerebral Perfusion Pressure and Health Outcomes: A Systematic ReviewCohen,
Lindsay et al. Annals of Emergency Medicine