Episode 45: Ketamine for suicidal ideation

Austin-Travis County EMS System Office of the Medical Director » Uncategorized

This study looks at an intriguing concept: What happens when you give an acutely suicidal patient ketamine in the ED? This study intrigued me so I thought I’d cover it. This study will not change your practice but will hopefully interest you in participating in research on the topic.

TL;DR/TL;DL: DON’T START DOING THIS YET. IT NEEDS MORE STUDY. But it is promising.

Citation: Domany Y, Shelton RC, McCullumsmith CB. Ketamine for acute suicidal ideation. An emergency department intervention: A randomized, double-blind, placebo-controlled, proof-of-concept trial. Depress Anxiety. 2020 Mar;37(3):224-233. doi: 10.1002/da.22975. Epub 2019 Nov 16. PMID: 31733088.

Strengths: Randomized placebo controlled design. Disposition and care for patients was determined before randomization, so study drug not likely to affect care delivered. Close assessment at multiple points. Administration protocol was over 5 min, so very conducive to the ED environment.

Weaknesses: Too small to really tell us how effective this treatment is, though there is a body of literature that supports it in other settings. Evaluation of patients was thorough, more than what could be expected of a prehospital provider without substantial training. Study setting was an ED, not EMS. Does not answer the question of whether patients can be safely discharged to outpatient mental health treatment after receiving this drug.