Pre-hospital use of Ketamine in Mountain Rescue: a Survey of Emergency Physicians from an Alpine Helicopter-based Emergency Service.

Résumé 0

Introduction Although ketamine use in emergency medicine is widespread, studies investigating its prehospital use are scarce. Our objective was to assess the self-reported modalities of ketamine use, knowledge of contraindications and adverse events associated with the use of ketamine by physicians through a prospective online survey. Methods The survey was addressed to physicians working for Air-Glaciers, a Swiss alpine helicopter-based emergency service (HEMS) and was available between 24 September and 23 November 2018. We enrolled 39 participants (participation rate of 87%), and collected data regarding characteristics of physicians, mode of use of ketamine, knowledge of contraindications and side effects linked to ketamine administration, as well as a clinical scenario investigating analgesia strategy Results Ketamine was considered safe, and judged irreplaceable by most physicians. The main reason for ketamine use was acute analgesia during very painful procedures, such as femoral fracture manipulation. Most physicians reported using opiates and midazolam concomitantly, while monitoring use and oxygen administration were used infrequently. The most frequently reported side effect was hallucinations, mainly visual and auditory. There was a general lack of knowledge among physicians regarding contraindications to the use of ketamine. Conclusion This study represent a picture of current state of the practice and knowledge for the use of ketamine in a pre-hospital, remote environment and suggest room for improvement in terms of knowledge of the contraindications.