{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T17:45:26Z","timestamp":1783619126068,"version":"3.55.0"},"reference-count":26,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2021,4,9]],"date-time":"2021-04-09T00:00:00Z","timestamp":1617926400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Rapid sequence intubation (RSI) is used to secure the airway of traumatic brain injury (TBI) patients, with ketamine frequently used for induction. Studies show that ketamine\u2010induction RSI might cause lower blood pressures when compared to etomidate. It is not clear if the results from that research can be extrapolated to systems that use different dosing regimens for ketamine RSI. Ambulance Victoria authorized the use of 1.5\u00a0mg\/kg ketamine in January 2015 for head injury RSI induction by road\u2010based paramedics. This study aims to examine whether systolic blood pressure changed when ketamine was introduced for prehospital head injury RSI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study was a retrospective analysis of out\u2010of\u2010hospital suspected TBI that received RSI by paramedics. Our analysis employs an interrupted time\u2010series analysis (ITSA), which is a quasi\u2010experimental method that tested whether hypotension and systolic blood pressures changed after the switch to ketamine induction in 2015. This ITSA utilized an ordinary least squares regression on complete observations using Newey\u2013West standard errors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During the study period, paramedics performed RSI in 8,613 patients, and 1,759 (20.4%) had a TBI. Ketamine usage increased by 52.7% in January 2015 (p<jats:italic>\u00a0<\/jats:italic>&lt;\u00a00.001) after road\u2010based paramedics were authorized to use ketamine induction. This analysis found significant 5% increase in post\u2010RSI hypotension (p<jats:italic>\u00a0<\/jats:italic>=\u00a00.046) after the introduction of ketamine, and thereafter the incidence of post\u2010RSI hypotension increased steadily by 0.5% every 3\u00a0months (p<jats:italic>\u00a0<\/jats:italic>=\u00a00.004). Concurrently, changes in systolic blood pressure, as measured by the interval just before induction to the last measured on scene, show an average decrease of 7.8\u00a0mm\u00a0Hg (p<jats:italic>\u00a0<\/jats:italic>=\u00a00.04) at the start of 2015 with the ketamine rollout.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This ITSA shows that postinduction hypotension and also decreases in systolic blood pressures became evident after the introduction of ketamine. Further research to investigate the association between ketamine induction and survival is needed.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.14256","type":"journal-article","created":{"date-parts":[[2021,3,24]],"date-time":"2021-03-24T07:47:19Z","timestamp":1616572039000},"page":"1134-1141","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["The association of ketamine induction with blood pressure changes in paramedic rapid sequence intubation of out\u2010of\u2010hospital traumatic brain injury"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7299-1363","authenticated-orcid":false,"given":"Pieter F.","family":"Fouche","sequence":"first","affiliation":[{"name":"Department of Paramedicine Monash University Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Meadley","sequence":"additional","affiliation":[{"name":"Department of Paramedicine Monash University Ambulance Victoria Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toby","family":"St Clair","sequence":"additional","affiliation":[{"name":"Department of Paramedicine and Department of Trauma Ambulance Victoria Monash University The Royal Children\u2019s Hospital Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison","family":"Winnall","sequence":"additional","affiliation":[{"name":"Ambulance Victoria Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul A.","family":"Jennings","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Preventive Medicine and Department of Paramedicine Ambulance Victoria Monash University Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Bernard","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Preventive Medicine Centre for Research and Evaluation Ambulance Victoria Monash University The Alfred Hospital Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Preventive Medicine and Department of Paramedicine Ambulance Victoria, Research and Evaluation Monash University Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,4,9]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.5863\/1551-6776-17.2.142"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60949-1"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.14063"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amj.2019.11.003"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2016.08.009"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.14070"},{"issue":"181","key":"e_1_2_10_8_1","first-page":"e2","article-title":"Hemodynamic response after rapid sequence induction with ketamine in out\u2010of\u2010hospital patients at risk of shock as defined by the shock index","volume":"68","author":"Miller M","year":"2016","journal-title":"Ann Emerg Med."},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2013.03.041"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-019-53360-6"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h2750"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1442-2026.2002.00382.x"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3181efc15f"},{"key":"e_1_2_10_14_1","unstructured":"Clinical Practice Guidelines for Ambulance and MICA paramedics. 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