EMS ketamine use on patients intoxicated with cocaine increases intubation

A study from Florida Atlantic University found IM ketamine administration increases ED intubation rate 5.75-fold for patients testing positive for cocaine

By Kerri Hatt

BOCA RATON, Fla. — Although ketamine use is prevalent, evidence on safety and efficacy is limited and risk factors for respiratory arrest and intubation have not been well studied.

Researchers from Florida Atlantic University’s Schmidt College of Medicine recently conducted a study to explore whether patients treated with prehospital ketamine for excited delirium with associated substance intoxication have higher rates of subsequent intubation in the ED compared to those without confirmed substance usage, according to a Newswise release.

Results of the study, published in the journal “Prehospital and Disaster Medicine,” showed that among 86 patients given IM ketamine for excited delirium in the prehospital setting, those with cocaine intoxication had a statistically significant 5.75-fold increased rate of subsequent intubation in the emergency department, which was higher in men than women. There were no deaths reported. 

Patients testing positive for alcohol, amphetamines, barbiturates, benzodiazepines, ecstasy, marijuana, opiates and synthetic cathinones (both bath salts and flakka) had similar rates of intubation compared to those negative for these substances. Baseline characteristics – age, ketamine dose and body mass index – were similar between those who did or did not undergo intubation.  

“While additional research is needed, it is tempting to speculate about possible mechanisms whereby prehospital ketamine administered intramuscularly for excited delirium with concomitant cocaine intoxication may increase subsequent intubation in the emergency department,” said first author Joshua J. Solano, MD, an emergency medicine physician, assistant professor of emergency medicine and integrated medical science, and director of quality improvement and patient safety, FAU Schmidt College of Medicine. “One plausible explanation is that cocaine may deplete excitatory neurotransmitters and lead to an exaggerated respiratory depression requiring intubation.” 


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