ED Treatment of Suicidal Patients With Ketamine Infusion
试验速览
- 阶段
- 2 期
- 状态
- 撤回
- 试验地点
- 1
- 主要终点
- Suicidal ideation at 24 hours post-infusion
研究概览
简要总结
This study aims to determine if a single intravenous (IV) dose of ketamine given in the emergency department (ED) can provide a long term reduction in suicidal ideation, lower time to ED discharge, and increase discharge to home or voluntary treatment facilities all while being safe.
详细描述
Suicide has risen to the 2nd leading cause of death in Americans aged 10 to 34, and is the10th leading cause of death overall. Globally, the World Health Organization estimates one person dies of suicide every 40 seconds. Despite its lethality, no recognized acute treatments for suicidality exist. Recently, ketamine, an N-methyl-D-aspartate (NMDA) receptor agonist, has been shown to rapidly reduce suicidality in small studies in psychiatric settings. However, most patients with acute suicidal thoughts are treated initially in Emergency Departments (EDs). Delays in treatment have both short and long term impacts on recovery as patients spend longer time frames in an actively suicidal state.
Identifying a rapid and effective treatment for suicidal ideation that can be administered in the ED would have a profound impact on the emergent management of patients with suicidal thoughts. Ketamine is an FDA approved medication that is commonly used in EDs for multiple indications. EDs have the familiarity, facilities and personnel to safely administer IV ketamine.
Ketamine is regularly used in EDs in high doses for procedural sedation in adults and children. It is also used in high doses as a sedative for acutely agitated patients. In low-doses ketamine is frequently used for its analgesic properties and is considered safe.
Ketamine has also been safely used in the pre-hospital setting. In a recent joint policy statement of the American College of Emergency Physicians recommended the use of low-dose ketamine for pain in control with a safety profile comparable to other intravenous analgesia such as morphine.
Use of Ketamine to rapidly reduce suicidality may facilitate a safe and faster transition of acutely suicidal patients to outpatient treatment. Such treatment potentially shortens these patients' ED and hospital lengths of stay.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Age ≥ 18 years
- •Chief complaint of suicidal thoughts with a MADRS-SI score > 3
- •Major depressive episode with MADRS > 19 (moderate to severe)
排除标准
- •Pregnancy
- •Psychosis
- •Acute intoxication with alcohol or illicit drugs
- •Acute withdrawal from alcohol or illicit drugs
- •Adults otherwise unable to consent
- •Concurrent, active medical illness requiring medical hospitalization
- •Inability to follow-up including no permanent address or valid telephone number
- •Patients unable to attend outpatient follow-up (no medical insurance, refusal to follow-up, no established care provider)
- •Specific contraindication to the use of ketamine (concern for increased intracranial or intraocular pressure, known allergy to ketamine)
- •Greater than 12 hours from time of ED presentation
- •Prisoners
研究组 & 干预措施
Treatment with Ketamine
In this arm an IV infusion of 0.5 mg/kg of ketamine will be administered over 40 minutes.
干预措施: Ketamine (Drug)
结局指标
主要结局
Suicidal ideation at 24 hours post-infusion
时间窗: 24 hours post-infusion
Suicidal ideation as measured by the Montgomery-Asberg Depression Scale (MARDS) will be assessed at 24 hours post-infusion of ketamine. The scale is a series of 10 questions each having a possible score of 0-6. Total scores are reported on a scale from 0-60, with lower numbers indicating less depression and higher numbers indicative of increasing depression.
Incidence of Discharge to Outpatient vs. Inpatient Facilities
时间窗: Through ED stay, an average of 53 hours
The investigators will collect information about what location patients enrolled in this study are discharged to (E.g. home, outpatient crisis residential facility, inpatient psychiatric hospital, admission to general hospital).
Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability]
时间窗: 1 week from enrollment.
Patients will be monitored for adverse events during the course of this study.
次要结局
- Overall MARDS score(1 hour, 3 days, and 1 week post-infusion)
- MARDS Suicidal Ideation (MARDS-SI) score(1 hour, 3 days, and 1 week post-infusion)
- Scale for Suicide Ideation-5 (SSI5) score(1 hour, 3 days, and 1 week post-infusion)
- ED length of stay(Through ED stay, an average of 53 hours)