Bebarta Vikhyat S, Mora Alejandra G, Bebarta Emma K, Reeves Lauren K, Maddry Joseph K, Schauer Steve G, Lairet Julio R
59th MDW/Chief Scientist Office, USAF En Route Care Research Center, JBSA-Lackland, TX; U.S. Army Institute of Surgical Research, Fort Sam Houston, TX, 1100 Wilford Hall Loop, JBSA-Lackland, TX 78236.
Department of Emergency Medicine, University of Colorado School of Medicine, 12401 E. 17th Avenue, Aurora, CO 80045.
Mil Med. 2020 Jan 7;185(Suppl 1):136-142. doi: 10.1093/milmed/usz302.
Ketamine is used as an analgesic for combat injuries. Ketamine may worsen brain injury, but new studies suggest neuroprotection. Our objective was to report the outcomes of combat casualties with traumatic brain injury (TBI) who received prehospital ketamine.
This was a post hoc, sub-analysis of a larger prospective, multicenter study (the Life Saving Intervention study [LSI]) evaluating prehospital interventions performed in Afghanistan. A DoD Trauma Registry query provided disposition at discharge and outcomes to be linked with the LSI data.
For this study, we enrolled casualties that were suspected to have TBI (n = 160). Most were 26-year-old males (98%) with explosion-related injuries (66%), a median injury severity score of 12, and 5% mortality. Fifty-seven percent (n = 91) received an analgesic, 29% (n = 46) ketamine, 28% (n = 45) other analgesic (OA), and 43% (n = 69) no analgesic (NA). The ketamine group had more pelvic injuries (P = 0.0302) and tourniquets (P = 0.0041) compared to OA. In comparison to NA, the ketamine group was more severely injured and more likely to require LSI procedures, yet, had similar vital signs at admission and disposition at discharge.
We found that combat casualties with suspected TBI that received prehospital ketamine had similar outcomes to those that received OAs or NAs despite injury differences.
氯胺酮用作战伤的镇痛药。氯胺酮可能会加重脑损伤，但新研究表明其具有神经保护作用。我们的目的是报告在院前接受氯胺酮治疗的创伤性脑损伤（TBI）战斗伤员的结局。
这是一项对一项更大的前瞻性多中心研究（“救生干预研究”[LSI]）的事后亚分析，该研究评估了在阿富汗进行的院前干预措施。国防部创伤登记处的查询提供了出院时的处置情况和结局，以便与LSI数据相关联。
在本研究中，我们纳入了疑似患有TBI的伤员（n = 160）。大多数是26岁的男性（98%），有爆炸相关损伤（66%），损伤严重程度评分中位数为12，死亡率为5%。57%（n = 91）接受了镇痛药，29%（n = 46）接受了氯胺酮，28%（n = 45）接受了其他镇痛药（OA），43%（n = 69）未接受镇痛药（NA）。与OA组相比，氯胺酮组有更多的骨盆损伤（P = 0.0302）和使用止血带的情况（P = 0.0041）。与NA组相比，氯胺酮组受伤更严重，更有可能需要进行LSI程序，然而，入院时生命体征和出院时处置情况相似。
我们发现，疑似TBI的战斗伤员在院前接受氯胺酮治疗，尽管存在损伤差异，但结局与接受OA或NA治疗的伤员相似。
