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Rapid Agitation Control with Ketamine in the Emergency Department (RACKED) Study

Principal Investigator: Dr. David Barbic

Status: Ongoing

The Rapid Agitation Control with Ketamine in the Emergency Department (RACKED) Study will compare the effectiveness of intramuscular ketamine to a standard combination of intramuscular medications in patients presenting to the emergency department (ED) with agitation and violent behaviour.

CHÉOS Scientist and ED physician David Barbic is leading the study, which is funded by the St. Paul’s Emergency Department Research Fund, the Canadian Association of Emergency Physicians, and PHCRI. CHÉOS Scientists Drs. Brian GrunauHubert Wong, and Frank Scheuermeyer are co-investigators on the team. CHÉOS will also provide of project management, regulatory affairs, data management, programming, and statistical support.

When patients arrive at the emergency department (ED) agitated, aggressive, and with potentially violent behaviour, it is paramount to find a way to address the situation quickly for the safety of patients and ED staff. Patients may be suffering from mental health crises, substance misuse, severe infections, or trauma, and caring for them and other patients is a primary concern for ED staff. This randomized control trial investigates the use of intramuscular (IM) ketamine compared to current standard care medications for the rapid and safe control of patients in the ED who present to the ED with aggression or violent behaviour.

The RACKED study will enroll 184 patients in the ED at St. Paul’s Hospital; participants will be randomized to receive either ketamine or a combination of midazolam (a benzodiazepine) and haloperidol (a typical antipsychotic). All investigators and study staff, excluding the study nurse administering treatment, will be blinded to the group allocation.

The primary outcome is time to adequate behaviour control, measured using the Richmond Agitation Sedation Scale. Secondary outcomes include the safety and tolerability of ketamine, rates of side effects, and the requirement of other medications to achieve sedation.

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Health research in the heart of Vancouver