Ketamine reduces the need for intubation in patients with acute severe mental illness and agitation requiring transport to definitive care: An observational study.
OBJECTIVE
The aim of this study was to review mental health patients transported by a dedicated statewide critical care retrieval team before and after the implementation of a ketamine sedation guideline.


METHODS
This is a a retrospective cohort study of mental health patients with acute behavioural disturbance, transported between January 2010 and December 2015.


RESULTS
A total of 78 patients were transported in the study period, 50 before and 28 after implementation of the ketamine guideline in June 2013. The introduction of the ketamine guideline was associated with a significant reduction in intubation for transport (36.00 vs 7.14%) (odds ratio 0.14, 95% confidence interval 0.02-0.71, P < 0.01). The likelihood of utilising ketamine for non-intubated patients (n = 58) was higher in the period after implementation (37.50 vs 84.62%, odds ratio 9.17, 95% confidence interval 2.54-33.08, P < 0.005). The incidence of complications in our series was low.


CONCLUSIONS
The implementation of a ketamine clinical practice guideline for agitated mental health patients was associated with an increase in the number of patients receiving ketamine as part of their sedation regime and a reduction in the number of patients requiring intubation for transport. Appropriately trained critical care retrieval teams should consider ketamine as part of the sedation regime for agitated mental health patients.
Emergency Medical Retrieval Service, SAAS MedSTAR, Adelaide, South Australia, Australia.
Cathrin S
CS
Parsch
Emergency Medical Retrieval Service, SAAS MedSTAR, Adelaide, South Australia, Australia.
Adrianne
A
Boonstra
Emergency Medical Retrieval Service, SAAS MedSTAR, Adelaide, South Australia, Australia.|Emergency Department, Flinders Medical Centre, Adelaide, South Australia, Australia.
David
D
Teubner
Emergency Medical Retrieval Service, SAAS MedSTAR, Adelaide, South Australia, Australia.
Wade
W
Emmerton
Rural and Remote Mental Health Services, Adelaide, South Australia, Australia.
Brian
B
McKenny
Emergency Medical Retrieval Service, SAAS MedSTAR, Adelaide, South Australia, Australia.
Daniel Y
DY
Ellis
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology / Q000627:therapeutic use; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data*; D007649:Ketamine / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy*; D008875:Middle Aged; D010360:Patient Transfer / Q000639:trends*; D012189:Retrospective Studies
D006993:Hypnotics and Sedatives; D007649:Ketamine
aeromedical; intubation; ketamine; mental health; psychiatric; retrieval; sedation; transport