Objectives: To describe the use of ketamine in children by a pre-hospital physician-based service.
Methods: A five and a half year retrospective database review of all patients aged <16 years who were attended by London's Helicopter Emergency Medical Service and given ketamine.
Results: One hundred and sixty-four children met the inclusion criteria. The median age was 10 years (range 0-15 years). One hundred and four (63%) had a Glasgow Coma Scale (GCS) of 15 and 153 (93%) had a GCS>8 before administration of ketamine. Patients received from 2 to 150 mg ketamine IV (mean=1.0 mg/kg) and 112 (68%) received concomitant midazolam (0.5-18 mg, mean=0.1 mg/kg). One hundred and forty-one (86%) received ketamine intravenously and 23 (14%) intramuscularly. Only 12 patients (7%) were trapped. The most common mechanisms of injury in those who received ketamine were road traffic collisions, burns and falls.
Conclusion: The safe delivery of adequate analgesia and appropriate sedation is a priority in paediatric pre-hospital care. Ketamine was predominantly used in awake non-trapped patients with blunt trauma for procedural sedation and analgesia. Detailed database searches did not demonstrate loss of airway, oxygen desaturation or clinically significant emergence reactions after ketamine administration. This study failed to demonstrate any major side effects of the drug and reassured us that the safety profile of the drug in this environment is likely to be satisfactory. The use of ketamine in trapped children was rare.