Pre-Hospital Providers Use of Ketamine for Rapid Sequence Intubation

Abstract

Patients are injected with anesthetics to produce analgesia, amnesia, and arreflexia for many different reasons such as surgery, invasive procedures, and emergency interventions; one anesthetic induction technique is rapid sequence intubation (RSI). The RSI technique is performed to safely control the airway in patients needing immediate airway management. A particular induction anesthetic with increased use in the pre-hospital arena is ketamine. In October 2016, Ketamine was added to the RSI protocol of one pre-hospital organization whereby providers can use ketamine as an induction agent. Purpose. The purpose of this project is to determine if there is a relationship between pre-hospital providers (PHPs) choice of using ketamine to facilitate intubation and knowledge about the anesthetic agent in regards to the adult trauma patient. Setting. The setting to this project was a local pre-hospital organization located in Gilbert, Arizona. Participants. The participants of this project are PHPs who maintain an active national and Arizona Department of Health Services (AZDHS) certification as emergency medical technician-paramedics (EMT-P). Method. An online survey was disseminated that included questions regarding frequency of ketamine use, knowledge of ketamine as well as questions regarding their choice of induction agent. Results. The response rate was 32.3%. The majority of PHP's have greater than 10 years experience as a certified emergency paramedic (68.8%) and less than half (38.7%) of the certified emergency paramedics (CEP) have used ketamine for RSI. Of the respondents that have 10 used ketamine as an induction agent, the majority (66.0%) would choose ketamine over another induction agent. While the majority of respondents rate themselves as knowledgeable in the pharmacological profile of ketamine (93.8%), the majority has also had less than five hours of training on ketamine (59.4%). The overwhelming majority agreed that they would benefit from training on aspects of ketamine. Conclusion. The seasoned CEP's would choose ketamine over other induction agents for RSI of the adult patient. The choice to use ketamine is based upon self-reported pharmacological knowledge of the drug. The limited occurrence of RSI and use of ketamine supports continual training on the use of ketamine and the RSI technique.