Barbic D, et al. Ann Emerg Med. 2021 Aug 2:S0196-0644(21)00433-9.
Question and Methods: Randomized, single center, blinded clinical trial comparing the rapidity of onset, level of sedation and adverse effect profile of Ketamine versus the combination of Haldol and Midazolam for ED patients with severe psychomotor agitation.
Findings: Treatment with Ketamine had a significantly shorter median time to adequate sedation, defined as a RASS </= -1, when compared to Midazolam + Haldol (5.8 minutes vs 14.7 minutes, respectively) with a difference of 8.8 minutes, 95% CI of 3.0 to 14.5 (hazard ratio of 2.43, 95% CI of 1.43 to 4.12).
Limitations: Possible bias exists with the fact that this was a single center study performed at an urban academic center with a small sample size that had early termination and possible risks for unblinding through the study’s methodology.
Interpretation: Ketamine is a safe and feasible alternate option that achieves a desirable level of sedation for severely agitated patients in the ED more rapidly than the combination of Haldol/Midazolam with a similar safety profile.