760: KALMED: KETAMINE FOR SEVERE AGITATION MANAGEMENT IN THE EMERGENCY DEPARTMENT

Abstract

Introduction: Acute agitation is a common presentation in the emergency department (ED) and is of high concern due to safety risks for patients and the healthcare team. As a result, it is crucial to efficiently relieve agitation in these patients. Numerous studies conducted in the pre-hospital setting and the ED have found ketamine to be an effective agent with quicker onset of action than benzodiazepines or antipsychotics for initial control of acute agitation. Ketamine dosing in these studies ranged from 2-5 mg/kg IM (intramuscular). To date, there is no study comparing low-dose (LD), ~2 mg/kg, versus standard dose (SD), 4-5 mg/kg, ketamine IM for acute agitation.The purpose of this study was to assess the effectiveness and safety of ketamine IM < 2.5 mg/kg versus > 2.5 mg/kg for severe agitation. Methods: This was a single-center, retrospective, two-arm cohort. Adult patients that received ketamine IM for acute agitation in the ED were included in this study. Patients were excluded if they received another sedative within 30 minutes of ketamine administration. The primary outcome was resolution of agitation at 15 minutes after ketamine administration. Resolution of agitation was defined as documentation from a healthcare provider, lack of additional sedative agent within 30 minutes from ketamine administration, or ability to complete necessary procedures. The secondary outcomes included use of agitation rescue medications within 30 minutes, adverse events, and time to medical clearance. Results: Of the 82 patients with an IM ketamine order that were evaluated, 68 met the study criteria. The LD cohort included 52 patients while 16 patients received SD ketamine. Mean age, sex, baseline psychiatric/substance abuse history were similar between groups. Successful sedation was similar between groups, LD 88.5% compared to SD 93.8%, (p=0.998). Rescue sedation was required in 16% of LD patients in the low-dose group and 6.3% of SD patients (p=0.32). Respiratory intervention was required in 13.5% in LD arm and 31.4% in SD (p=0.89). Conclusions: LD and SD IM ketamine resulted in similar rates of successful sedation in acutely agitated patients in the ED.