Ketamine for emergency sedation of agitated patients: A systematic review and meta-analysis

Prior studies suggest that ketamine is effective for acute agitation in the emergency department (ED) and prehospital settings. This systematic review and meta-analysis aims to evaluate the rate of sedation and need for airway management in patients given ketamine for management of acute agitation. Methods: We performed a systematic review of publications describing the use of ketamine to control agitation in the ED and prehospital settings. Studies were included if they included agitated patients, used ketamine to control agitation, occurred in the ED and prehospital setting and measured sedation status or need for airway management. Following data abstraction, a meta-analysis was performed to synthesize the rate of effective sedation and the need for airway management. Result: 13 studies met the inclusion criteria. 10 studies were conducted in the prehospital setting and 3 in the ED setting. The overall proportion of subjects receiving airway management across all 13 studies was 20% (95% CI = 0.0489-1.6505). The estimate of the proportion of subjects that achieved sedation was 85% (95% CI = 0.71-0.93). After synthesizing data from the four studies that compared ketamine to controls, ketamine was associated with increased rates of sedation (RR, 1.95 [CI, 0.47-8.1]) and increased need for intubation (RR, 2.44 [CI, 0.75-7.91]). The differences were not significant by random effects model. (C) 2019 Elsevier Inc. All rights reserved.