Ann Emerg Med

Ketamine vs. midazolam: Do airway outcomes differ in acute agitation?

April 21, 2025

Study details: This retrospective cohort study compared the need for emergent airway support following administration of midazolam or ketamine to treat acute behavioral disturbance in 376 patients (median age, 35; 75% male) treated by an urban EMS system between 2017 and 2021. Advanced airway management was defined as out-of-hospital endotracheal intubation or supraglottic airway insertion.

Results: The frequency of advanced airway management was similar between the midazolam and ketamine groups (12% vs. 11%; difference 0.5%; 95% confidence interval [CI] -6.0% to 7.0%). Adjusted odds ratio (aOR) of receiving advanced airway management didn't differ significantly between the two groups (aOR 1.02; 95% CI 0.44 - 2.38). No differences were observed between midazolam and ketamine for emergency department intubation rates (14% vs. 11%) or overall mortality (2% vs. 1%).

Clinical impact: Ketamine and midazolam were equally effective in managing acute behavioral disturbance in the out-of-hospital setting, with similar rates of emergent airway support. This information could guide EMS providers in selecting appropriate sedative agents for patients with acute behavioral disturbances.

Source:

Muldowney M, et al. (2024, October 21). Ann Emerg Med. A Comparison of Ketamine to Midazolam for the Management of Acute Behavioral Disturbance in the Out-of-Hospital Setting. https://pubmed.ncbi.nlm.nih.gov/39436328/