STUDY OBJECTIVE To determine if ketamine, when added to midazolam for the treatment of out-of-hospital seizures, is associated with an increase in the rate of cessation of convulsions prior to hospital arrival. METHODS We performed a retrospective cohort study of out-of-hospital patients with an active convulsive seizure being transported to a hospital by a large emergency medical services system in Florida, using data from August 1, 2015 and August 5, 2024. Per protocol, patients received midazolam first for their seizure. Starting in June 2017, a new protocol was developed in which patients who continued to convulse after midazolam received ketamine. We used propensity score matching and multivariable logistic regression to determine if patients who received ketamine were more likely to stop convulsing prior to hospital arrival than those who received midazolam alone. RESULTS Overall, 479 (80.1%) of 598 actively convulsing patients who received 2 doses of midazolam (without subsequent ketamine) had resolution of their convulsions prior to hospital arrival compared with 85 (94.4%) of 90 who received ketamine after midazolam, an absolute difference between groups of 14.3% (95% CI 8.6% to 20.1%). After propensity matching, 82.0% of those in the midazolam only group had resolution of convulsions compared to 94.4% in the ketamine group, a difference of 12.4% (95% CI 3.1% to 21.7%). CONCLUSION In this retrospective study of out-of-hospital patients with active convulsive seizures, patients who received ketamine were more likely to have stopped convulsing prior to hospital arrival than those who received midazolam alone.

中文翻译：

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咪达唑仑和氯胺酮治疗院外惊厥性癫痫持续状态。


研究目的 确定氯胺酮加入咪达唑仑治疗院外癫痫发作时，是否与到达医院前惊厥停止率的增加有关。方法 我们使用 2015 年 8 月 1 日和 2024 年 8 月 5 日的数据，对佛罗里达州一家大型紧急医疗服务系统将活动性惊厥性癫痫发作的院外患者进行了一项回顾性队列研究。根据方案，患者首先接受咪达唑仑治疗癫痫发作。从 2017 年 6 月开始，制定了一种新的方案，其中咪达唑仑后继续抽搐的患者接受氯胺酮治疗。我们使用倾向评分匹配和多变量 logistic 回归来确定接受氯胺酮治疗的患者是否比单独接受咪达唑仑治疗的患者更有可能在到达医院前停止抽搐。结果 总体而言，接受 2 剂咪达唑仑（无后续氯胺酮）的 598 名活动性惊厥患者中有 479 名 （80.1%） 在到达医院前惊厥消退，而在咪达唑仑后接受氯胺酮治疗的 90 名患者中有 85 名 （94.4%），组间绝对差异为 14.3%（95% CI 8.6% 至 20.1%）。倾向匹配后，仅咪达唑仑组 82.0% 的患者惊厥消退，而氯胺酮组为 94.4%，差异为 12.4% （95% CI 3.1% 至 21.7%）。结论 在这项针对活动性惊厥性癫痫发作的院外患者的回顾性研究中，接受氯胺酮治疗的患者比单独接受咪达唑仑治疗的患者更有可能在到达医院前停止惊厥。