Introduction: Ketamine has gained increased utilization for the treatment of status epilepticus (SE), specifically in super refractory status epilepticus (SRSE) treatment regimens. Ketamine is theorized to be beneficial in SE patients due to its antagonism of N-methyl-D-aspartate (NMDA) receptors which leads to decreased neuronal death by decreased openings of NMDA-associated cation channel. This study investigated the efficacy of ketamine use in refractory status epilepticus (RSE) and SRSE, focusing primarily on the time to seizure cessation in patients who received ketamine versus those who did not. Methods: The study was a single center, retrospective chart review of SE patients admitted to Baptist Memorial Hospital-Memphis from August 1, 2021 to August 31, 2023. The non-ketamine group included patients who presented during the national ketamine shortage, which began in March of 2023. All adult patients who had confirmed RSE diagnosis and greater than two antiepileptic agents in addition to initial benzodiazepine therapy were included. Patients were identified via the electronic medical record system. The primary outcome was the time to seizure cessation. Secondary outcomes included ICU length of stay, hospital length of stay, and inpatient mortality rate. Results: There were 51 patients included (n=39 ketamine, n=12 non-ketamine) for analysis. There was a statistically significant difference in the primary outcome of time to seizure cessation (ketamine median 24.6 hours 12.4-64.1 vs. non-ketamine median 57.2 hours 40.2-105.5). The secondary outcomes of ICU length of stay, hospital length of stay, and inpatient mortality were not statistically significant. Conclusions: Utilization of ketamine was associated with a statistically significant reduction in time to seizure cessation in patients with RSE and SRSE. While we did not find a statistical difference in the secondary outcomes, facility placement issues were identified as a contributing factor to prolonged hospital length of stay in both groups. Further studies are needed to investigate if earlier initiation of ketamine results in improved outcomes for RSE patients.
Mitchell et al. (Sun,) studied this question.