Midazolam for the treatment of out-of-hospital pediatric seizures.
OBJECTIVE
To assess the effectiveness and safety of intravenous (IV) and intramuscular (IM) midazolam in the treatment of pediatric seizures by paramedics.


METHODS
All cases in which paramedics treated patients under the age of 18 years with midazolam for seizures per county protocol were evaluated over a one-year period. Prehospital records were reviewed for treatment and reassessment, while the subgroup of patients who were transported to Children's Hospital were followed up for emergency department (ED) outcome.


RESULTS
Midazolam was administered to 86 pediatric patients with ages ranging from 2 months to 14 years for the treatment of seizures per county protocol. There were 54 IV doses and 32 IM doses delivered. Of the 86 patients, post-intervention reevaluation was documented for 74 patients (86%) representing 49 IV and 25 IM doses. Improvement was reported for 91% (67/74) of patients. Greater success was reported with IV drug administration (47/49, 96%) as compared with 80% (20/25) with IM administration (p < 0.05). Four patients (three treated IM and one IV) had respiratory compromise necessitating field airway management. All four patients had respiratory compromise documented prior to midazolam administration. Forty-four patients were treated at Children's Hospital. Seven were intubated in the ED after having been given additional medications for seizures. None were intubated on arrival and none were felt to require intubation secondary to midazolam-induced respiratory depression.


CONCLUSIONS
Prehospital IV midazolam is an effective intervention for pediatric seizures, while IM midazolam was associated with a 20% failure rate, with both having minimal risk of respiratory compromise.
Vilke
Gary M
GM
Department of Emergency Medicine, University of California, San Diego Medical Center, 92103, USA. gmvilke@ucsd.edu
Sharieff
Ghazala Q
GQ
Marino
Allen
A
Gerhart
Ann E
AE
Chan
Theodore C
TC
D000293:Adolescent; D002140:California; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D004632:Emergency Medical Services / Q000592:standards*; D004634:Emergency Medical Technicians; D005260:Female; D006302:Health Services Research; D006776:Hospitals, Pediatric; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000627:therapeutic use*; D007223:Infant; D007262:Infusions, Intravenous; D007273:Injections, Intramuscular; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D012449:Safety; D012640:Seizures / Q000188:drug therapy*; D016896:Treatment Outcome
D006993:Hypnotics and Sedatives; D008874:Midazolam