PMID- 36776280
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230214
IS  - 2667-193X (Electronic)
IS  - 2667-193X (Linking)
VI  - 9
DP  - 2022 May
TI  - Adverse events following emergent prehospital sedation of patients with 
      behavioral emergencies: A retrospective cohort study.
PG  - 100183
LID - 10.1016/j.lana.2021.100183 [doi]
LID - 100183
AB  - BACKGROUND: Patients presenting to emergency medical services (EMS) with 
      behavioral emergencies may require emergent sedation to facilitate care, but 
      concerns about sedation-related adverse events (AEs) exist. This study aimed to 
      describe the frequency of AEs following emergent prehospital sedation with three 
      types of sedative agents: ketamine, benzodiazepines and antipsychotics. METHODS: 
      This retrospective cohort study included patients >/= 15 years who presented to 
      1031U.S. EMS agencies in calendar year 2019 with behavioral emergencies 
      necessitating emergent prehospital sedation. Serious AEs (SAE) included cardiac 
      arrest, invasive airway placement, and severe oxygen desaturation (<75%). 
      Less-serious AEs included positive pressure ventilation, any oxygen desaturation 
      (<90%), oropharyngeal or nasopharyngeal airway placement, and suctioning. The 
      need for additional sedation was also assessed. FINDINGS: Of 7973 patients, 1996 
      received ketamine; 4137 received a benzodiazepine; 1532 received an antipsychotic 
      agent; and 308 received an indeterminant agent. Cardiac arrest occurred in 11 
      patients (0.1%) and any SAE occurred in 165 patients (2.1%). Invasive airway 
      placement was more frequent with ketamine (40, 2.0%) compared with 
      benzodiazepines (17, 0.4%) or antipsychotics (3, 0.2%). Oxygen desaturation below 
      75% also occurred more frequently with ketamine (51, 2.6%) than with 
      benzodiazepines (52, 1.3%) or antipsychotics (14, 0.9%). Patients sedated with 
      ketamine were less likely to require additional sedation. Propensity-matching to 
      minimize potential confounding between patient condition, sedative choice and AEs 
      did not meaningfully alter the results. INTERPRETATION: Although SAEs were rare 
      among patients receiving emergent prehospital sedation, prehospital clinicians 
      should remain mindful of the potential risks and monitor patients closely. 
      FUNDING: None.
CI  - (c) 2022 The Author(s).
FAU - Brown, Lawrence H
AU  - Brown LH
AD  - Division of Emergency Medicine, Dell Medical School at the University of Texas, 
      1400N IH35, Suite 2.230, Austin, TX 78701, USA.
AD  - U.S. Acute Care Solutions, Canton, OH, USA.
FAU - Crowe, Remle P
AU  - Crowe RP
AD  - ESO Inc., Austin, TX, USA.
FAU - Pepe, Paul E
AU  - Pepe PE
AD  - Department of Management, Policy and Community Health, School of Public Health, 
      University of Texas Health Sciences Center, Houston, TX, USA.
AD  - Dallas County Emergency Medical Services and Public Safety Agencies, Dallas, TX, 
      USA.
FAU - Miller, Melissa L
AU  - Miller ML
AD  - Division of Emergency Medicine, Dell Medical School at the University of Texas, 
      1400N IH35, Suite 2.230, Austin, TX 78701, USA.
FAU - Watanabe, Brooke L
AU  - Watanabe BL
AD  - Division of Emergency Medicine, Dell Medical School at the University of Texas, 
      1400N IH35, Suite 2.230, Austin, TX 78701, USA.
AD  - U.S. Acute Care Solutions, Canton, OH, USA.
FAU - Kordik, Samuel S
AU  - Kordik SS
AD  - Cypress Creek EMS, Spring, TX, USA.
FAU - Wampler, David A
AU  - Wampler DA
AD  - Department of Emergency Health Sciences, UT Health San Antonio, San Antonio, TX, 
      USA.
FAU - Page, David I
AU  - Page DI
AD  - David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
AD  - Department of Paramedicine, Monash University, Melbourne, VIC, Australia.
FAU - Fernandez, Antonio R
AU  - Fernandez AR
AD  - ESO Inc., Austin, TX, USA.
FAU - Bourn, Scott S
AU  - Bourn SS
AD  - ESO Inc., Austin, TX, USA.
FAU - Myers, J Brent
AU  - Myers JB
AD  - ESO Inc., Austin, TX, USA.
LA  - eng
PT  - Journal Article
DEP - 20220115
PL  - England
TA  - Lancet Reg Health Am
JT  - Lancet regional health. Americas
JID - 9918232503006676
PMC - PMC9904026
OTO - NOTNLM
OT  - Antipsychotic Agents
OT  - Emergency Medical Services
OT  - behavioral symptoms
OT  - benzodiazepines
OT  - ketamine
COIS- The authors declare no competing or conflicting financial interests. RPC, ARF, 
      SSB and JBM are employed by ESO Inc., which provided the underlying data for this 
      analysis. JBM receives ESO stock options as a component of his employment 
      compensation package. JBM has also engaged in advocacy related to prehospital 
      sedation on behalf of the National Association of EMS Physicians and the American 
      College of Emergency Physicians.
EDAT- 2023/02/14 06:00
MHDA- 2023/02/14 06:01
PMCR- 2022/01/15
CRDT- 2023/02/13 03:16
PHST- 2023/02/13 03:16 [entrez]
PHST- 2023/02/14 06:00 [pubmed]
PHST- 2023/02/14 06:01 [medline]
PHST- 2022/01/15 00:00 [pmc-release]
AID - S2667-193X(21)00179-4 [pii]
AID - 100183 [pii]
AID - 10.1016/j.lana.2021.100183 [doi]
PST - epublish
SO  - Lancet Reg Health Am. 2022 Jan 15;9:100183. doi: 10.1016/j.lana.2021.100183. 
      eCollection 2022 May.