Lipscombe Carlos, Akhlaghi Hamed, Groombridge Christopher, Bernard Stephen, Smith Karen, Olaussen Alexander
Department of Paramedicine, Monash University, Melbourne, Victoria, Australia.
Emergency Department, St Vincent's Hospital, Melbourne, Victoria, Australia.
Prehosp Emerg Care. 2023;27(8):1016-1030. doi: 10.1080/10903127.2022.2108178. Epub 2022 Aug 30.
Ketamine is a fast-acting, dissociative anesthetic with a favorable adverse effect profile that is effective for managing acute agitation as a chemical restraint in the prehospital and emergency department (ED) settings. However, some previously published individual studies have reported high intubation rates when ketamine was administered prehospitally.
This systematic review aims to determine the rate and settings in which intubation following prehospital administration of ketamine for agitation is occurring, as well as associated indications and adverse events.
We searched PubMed, Scopus, Ovid MEDLINE, Embase, CINAHL Plus, PsycINFO, the Cochrane Library, ClinicalTrials.gov, OpenGrey, Open Access Theses and Dissertation, and Google Scholar from the earliest possible date until 13/February/2022. Inclusion criteria required studies to describe agitated patients who received ketamine in the prehospital setting as a first-line drug to control acute agitation. Reference lists of appraised studies were screened for additional relevant articles. Study quality was assessed using the Newcastle-Ottawa quality assessment scale. Synthesis of results was completed via meta-analysis, and the GRADE tool was used for certainty assessment.
The search yielded 1466 unique records and abstracts, of which 50 full texts were reviewed, resulting in 18 being included in the analysis. All studies were observational in nature and 15 were from USA. There were 3476 patients in total, and the overall rate of intubation was 16% (95% confidence interval [CI] = 8%-26%). Most intubations occurred in the ED. Within the studies, the prehospital intubation rate ranged from 0% to 7.9% and the ED intubation rate ranged from 0 to 60%. The overall pooled prehospital intubation rate was 1% (95% CI = 0%-2%). The overall pooled ED intubation rate was 19% (95% CI = 11%-30%). The most common indications for intubation were for airway protection and respiratory depression/failure.
There is wide variation in intubation rates between and within studies. The majority of intubations performed following prehospital administration of ketamine for agitation took place in the ED.
氯胺酮是一种起效迅速的解离性麻醉剂，具有良好的不良反应谱，在院前和急诊科作为化学约束手段用于处理急性躁动有效。然而，一些先前发表的个别研究报告称，院前使用氯胺酮时插管率较高。
本系统评价旨在确定院前使用氯胺酮治疗躁动后插管的发生率和场景，以及相关指征和不良事件。
我们检索了PubMed、Scopus、Ovid MEDLINE、Embase、CINAHL Plus、PsycINFO、Cochrane图书馆、ClinicalTrials.gov、OpenGrey、开放获取学位论文数据库以及谷歌学术，检索时间从最早日期至2022年2月13日。纳入标准要求研究描述在院前环境中接受氯胺酮作为控制急性躁动一线药物的躁动患者。对评估研究的参考文献列表进行筛查以寻找其他相关文章。使用纽卡斯尔-渥太华质量评估量表评估研究质量。通过荟萃分析完成结果综合，并使用GRADE工具进行确定性评估。
检索产生了1466条独特记录和摘要，其中50篇全文被审查，18篇被纳入分析。所有研究本质上均为观察性研究，15篇来自美国。总共有3476例患者，总体插管率为16%（95%置信区间[CI]=8%-26%）。大多数插管发生在急诊科。在这些研究中，院前插管率范围为0%至7.9%，急诊科插管率范围为0至60%。总体汇总的院前插管率为1%（95%CI=0%-2%）。总体汇总的急诊科插管率为19%（95%CI=11%-30%）。最常见的插管指征是气道保护和呼吸抑制/衰竭。
不同研究之间以及同一研究内部的插管率存在很大差异。院前使用氯胺酮治疗躁动后进行的大多数插管发生在急诊科。
