The following is a summary of “Midazolam and Ketamine for Convulsive Status Epilepticus in the Out-of-Hospital Setting,” published in the December 2024 issue of Emergency Medicine by Zitek et al.
Researchers conducted a retrospective study to determine whether adding ketamine to midazolam for out-of-hospital seizure treatment was linked to higher rates of convulsion cessation before hospital arrival.
They analyzed data from individuals experiencing active convulsive seizures transported by a large emergency medical services system in Florida, spanning August 1, 2015, to August 5, 2024. As per protocol, midazolam was administered 1st for seizure management. A new protocol was introduced in June 2017 for individuals who continued to convulse after midazolam received ketamine. A propensity score matching and multivariable logistic regression was used to assess whether ketamine recipients were more likely to stop convulsing before hospital arrival compared to those treated with midazolam alone (per protocol).
The results showed that 479 out of 598 individuals (80.1%) actively convulsing and treated with 2 doses of midazolam alone (without subsequent ketamine) experienced resolution of convulsions before hospital arrival, compared to 85 out of 90 individuals (94.4%) who received ketamine following midazolam. This reflected an absolute difference of 14.3% between the groups (95% CI 8.6% to 20.1%). After applying propensity score matching, 82.0% of individuals in the midazolam-only group had cessation of convulsions, while 94.4% in the ketamine group achieved the same, indicating a difference of 12.4% (95% CI 3.1% to 21.7%).
Investigators concluded the patients with active convulsive seizures who received ketamine were more likely to have stopped convulsing prior to hospital arrival than those who received only midazolam.
Source: annemergmed.com/article/S0196-0644(24)01195-8/abstract
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