A prospective review of the use of ketamine to facilitate endotracheal intubation in the helicopter emergency medical services (HEMS) setting
Bibliographic record
Abstract
INTRODUCTION: Ketamine is a dissociative agent used for sedation and intubation in various clinical settings. Despite its proven haemodynamic safety, ketamine has not been widely used in prehospital medicine. This study examined the use of ketamine in helicopter emergency medical services (HEMS). METHODS: This prospective cohort study enrolled all patients transported by a single HEMS program in whom ketamine was used to facilitate intubation. Data were collected using standard forms by two independent trained research staff. Demographics, medical condition, intubation conditions, vital signs (pre and post drug administration) and complications were recorded. Proportions, medians with IQR, change scores and CIs are reported; differences were compared using paired t tests. RESULTS: During the 2-year study period, 71 patients received ketamine to facilitate endotracheal intubation. Ketamine was used most often in men (52 (73%)), and the median age was 49 years (IQR: 31, 69). Most patients were adults (70 (99%)) with medical illnesses (42 (59%)); 37 (52%) intubations were performed at the sending hospital, and 30 (42%) were performed on scene. A paramedic performed the intubation in 58 cases (82%). The median ketamine dose was 80 mg (IQR: 60, 100; ~ 1mg/kg); 53 (75%) patients also received a paralytic agent. Mean arterial pressure (2.3 mmHg; 95% CI: -8.0 to 3.3) and heart rate (0.45 beats/min, 95% CI: -4.9 to 4.0) changes failed to reach statistical or clinical significance. No differences were found between patients with suspected concomitant head injury and other patients with respect to ketamine dose, changes in vital signs and complications. Complications included: one (1.4%) interstitial IV, five (7%) failed intubations, five (7%) hypotension and four (6%) hypertension episodes, one (1%) bradycardia, two (3%) tachycardia and five (7%) deaths. CONCLUSIONS: Ketamine is an effective agent in facilitating intubation in a HEMS environment. Complications are similar to use in the controlled Emergency Department setting.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.015 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.005 | 0.007 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".