Every so often I have thoughts about clinical trials I think might be really good, so when I have them I’ll be jotting them down here from hereon in.
Ketamine in asthma
Goyal and the Indian Journal of Critical Care Medicine published this (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3777369/) review of ketamine in status asthmaticus.
There has been one double blind randomised placebo controlled trial of ketamine as a bronchodilator since 2000, this was on paediatric patients and was with a smaller dose, there were no adverse effects. In this study a 0.2mg/kg bolus, and then 0.5mg/kg/hr for 2 hours was given; there was no significant improvement. The same was done in an adult study in the 1990s and there was also no significant improvement.
However in every paediatric case study and prospective, observational review with a bolus dose greater than 0.5mg/kg, and more often 1-2mg/kg, has shown a significant improvement.
The individual case studies and prospective, observational reviews (which, most of the time, have larger doses) are unanimous in that it improves patient condition.
My, probably naive, plan
If I could magic a study out of thin air, I would like an ambulance service and/or emergency department to do a double blind randomised placebo controlled trial of ketamine as a bronchodilator in the case of a silent chest, respiratory arrest and cardiac arrest when bronchospasm can reasonably thought to be a major contributory factor, and give a bolus of one of 2mg/kg, 0.2mg/kg or placebo, then 1mg/kg/hour for two hours. This would be on a population of those aged 6 and over with adults assumed to be 70kg and children’s weight (3 x age) + 7.