Abstract：
UNASSIGNED: Benzodiazepines are the primary antiseizure medication used by Emergency Medical Services (EMS) for seizures. Available literature in the United States and internationally shows 30% to 40% of seizures do not terminate with benzodiazepines called benzodiazepine refractory status epilepticus (BRSE). Ketamine is a potential treatment for BRSE due to its unique pharmacology. However, its application in the prehospital setting is mostly documented in case reports. Little is known about its use by EMS professionals for seizure management, whether as initial treatment or for BRSE, creating an opportunity to describe its current use and inform future research.
UNASSIGNED: We performed a retrospective review of 9-1-1 EMS encounters with a primary or secondary impression of seizure using the ESO Data Collaborative from 2018 to 2021. We isolated encounters during which ketamine was administered. We excluded medication administrations prior to EMS arrival and encounters without medication administration. Subgroup analysis was performed to control for airway procedure as an indication for ketamine administration. We also evaluated for co-administration with other antiseizure medications, dose and route of administration, and response to treatment.
UNASSIGNED: We identified 99,576 encounters that met inclusion. There were 2,531/99,576 (2.54%) encounters with ketamine administration and 50.7% (1,283/2,531) received ketamine without an airway procedure. There were 616 cases (48%, 616/1,283) where ketamine was given without another antiseizure medication (ASM) and without any airway procedure. The remaining 667 (52%) cases received ketamine with at least one other ASM, most commonly midazolam (89%, 593/667). Adjusted for the growth in the ESO dataset, ketamine use by EMS professionals during encounters for seizures without an airway procedure increased from 0.90% (139/15,375) to 1.45% (416/28,651) an increase of 62% over the study period.
UNASSIGNED: In this retrospective review of the ESO Data Collaborative, ketamine administration for seizure encounters without an airway procedure increased over the study period, both as a single agent and with another ASM. Most ketamine administrations were for adult patients in the south and in urban areas. The frequency of BRSE, the need for effective treatment, and the growth in ketamine use warrant prospective prehospital research to evaluate the value of ketamine in prehospital seizure management.
UNASSIGNED: We performed a retrospective review of 9-1-1 EMS encounters with a primary or secondary impression of seizure using the ESO Data Collaborative from 2018 to 2021. We isolated encounters during which ketamine was administered. We excluded medication administrations prior to EMS arrival and encounters without medication administration. Subgroup analysis was performed to control for airway procedure as an indication for ketamine administration. We also evaluated for co-administration with other antiseizure medications, dose and route of administration, and response to treatment.
UNASSIGNED: We identified 99,576 encounters that met inclusion. There were 2,531/99,576 (2.54%) encounters with ketamine administration and 50.7% (1,283/2,531) received ketamine without an airway procedure. There were 616 cases (48%, 616/1,283) where ketamine was given without another antiseizure medication (ASM) and without any airway procedure. The remaining 667 (52%) cases received ketamine with at least one other ASM, most commonly midazolam (89%, 593/667). Adjusted for the growth in the ESO dataset, ketamine use by EMS professionals during encounters for seizures without an airway procedure increased from 0.90% (139/15,375) to 1.45% (416/28,651) an increase of 62% over the study period.
UNASSIGNED: In this retrospective review of the ESO Data Collaborative, ketamine administration for seizure encounters without an airway procedure increased over the study period, both as a single agent and with another ASM. Most ketamine administrations were for adult patients in the south and in urban areas. The frequency of BRSE, the need for effective treatment, and the growth in ketamine use warrant prospective prehospital research to evaluate the value of ketamine in prehospital seizure management.
摘要：
目标：苯二氮卓类药物是急诊医疗服务（EMS）用于癫痫发作的主要抗癫痫药物。在美国和国际上可获得的文献表明，30％至40％的癫痫发作不会用苯二氮卓类药物终止，称为苯二氮卓类药物难治性癫痫持续状态（BRSE）。由于其独特的药理学，氯胺酮是BRSE的潜在治疗方法。然而,其在院前设置中的应用主要记录在病例报告中。关于EMS专业人员将其用于癫痫发作管理的情况知之甚少，无论是作为初始治疗还是BRSE，创造一个机会来描述其当前的用途，并为未来的研究提供信息。方法：我们使用2018-2021年的ESO数据协作对9-1-1例EMS发作的主要或次要印象进行了回顾性审查。我们隔离了服用氯胺酮的遭遇。我们排除了EMS到达之前的药物管理和没有药物管理的情况。进行亚组分析以控制气道程序作为氯胺酮给药的指征。我们还评估了与其他抗癫痫药物的联合给药，剂量和给药途径，以及对治疗的反应。结果：我们确定了99,576次符合纳入条件的遭遇。有2,531/99,576（2.54％）次使用氯胺酮，50.7％（1,283/2,531）在没有气道程序的情况下接受氯胺酮。有616例（48%，616/1,283），其中氯胺酮在没有其他抗癫痫药物（ASM）且没有任何气道手术的情况下使用。其余667例（52％）接受氯胺酮与至少一个其他ASM，最常见的是咪达唑仑(89%，593/667)。根据ESO数据集的增长进行了调整，EMS专业人员在没有进行气道操作的癫痫发作期间使用氯胺酮从0.90%(139/15,375)增加到1.45%(416/28,651),在研究期间增加了62%.结论：在本次ESO数据协作的回顾性综述中，在研究期间，氯胺酮在没有气道手术的情况下对癫痫发作的给药增加，既作为单一代理人，也与另一个ASM。大多数氯胺酮给药是针对南部和城市地区的成年患者。BRSE的频率,需要有效的治疗，氯胺酮使用的增长需要前瞻性院前研究来评估氯胺酮在院前癫痫发作管理中的价值。
