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Original Article
- Outcomes and physiologic responses associated with ketamine administration after traumatic brain injury in the United States and Canada: a retrospective analysis
- Austin J. Peters, Saad A. Khan, Seiji Koike, Susan Rowell, Martin Schreiber
- J Trauma Inj. 2023;36(4):354-361. Published online November 7, 2023
- DOI: https://doi.org/10.20408/jti.2023.0034
- 19,323 View
- 346 Download
- 9 Web of Science
- 8 Citations
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Abstract
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Supplementary Material - Purpose
Ketamine has historically been contraindicated in traumatic brain injury (TBI) due to concern for raising intracranial pressure. However, it is increasingly being used in TBI due to the favorable respiratory and hemodynamic properties. To date, no studies have evaluated whether ketamine administered in subjects with TBI is associated with patient survival or disability.
Methods
We performed a retrospective analysis of data from the multicenter Prehospital Tranexamic Acid Use for Traumatic Brain Injury trial, comparing ketamine-exposed and ketamine-unexposed TBI subjects to determine whether an association exists between ketamine administration and mortality, as well as secondary outcome measures.
Results
We analyzed 841 eligible subjects from the original study, of which 131 (15.5%) received ketamine. Ketamine-exposed subjects were younger (37.3±16.9 years vs. 42.0±18.6 years, P=0.037), had a worse initial Glasgow Coma Scale score (7±3 vs. 8±4, P=0.003), and were more likely to be intubated than ketamine-unexposed subjects (88.5% vs. 44.2%, P<0.001). Overall, there was no difference in mortality (12.2% vs. 15.5%, P=0.391) or disability measures between groups. Ketamine-exposed subjects had significantly fewer instances of elevated intracranial pressure (ICP) compared to ketamine-unexposed subjects (56.3% vs. 82.3%, P=0.048). In the very rare outcomes of cardiac events and seizure activity, seizure activity was statistically more likely in ketamine-exposed subjects (3.1% vs. 1.0%, P=0.010). In the intracranial hemorrhage subgroup, cardiac events were more likely in ketamine-exposed subjects (2.3% vs. 0.2%, P=0.025). Ketamine exposure was associated with a smaller increase in TBI protein biomarker concentrations.
Conclusions
Ketamine administration was not associated with worse survival or disability despite being administered to more severely injured subjects. Ketamine exposure was associated with reduced elevations of ICP, more instances of seizure activity, and lower concentrations of TBI protein biomarkers. -
Summary
Citations
Citations to this article as recorded by
- Is ketamine safe for traumatic brain injury? A systematic review and meta-analysis
João Vitor Sciorilli, Yohanna Idsabella Rossi, Rodrigo dos Reis Schevz, Davi Barbosa Pereira da Silva, Josué Lee, Flávio Gallani, Marc Maegele
Journal of Critical Care.2026; 91: 155347. CrossRef - Analgesic and Physiologic Effects of Ketamine Compared to Opioids in Prehospital Trauma Care: A Systematic Review and Meta-Analysis
Anna C Meyer, Maryrose Kuo, David M Duriancik
The Journal of Emergency Medicine.2026;[Epub] CrossRef - Outcomes associated with ketamine administration following traumatic brain injury
Jonathan Dallas, Hyoungjin Park, Robert G. Briggs, David J. Cote, Frank J. Attenello, Gabriel Zada
Journal of Clinical Neuroscience.2026; 148: 111968. CrossRef - Ketamine is Associated with Increased 24-Hour Mortality Following Traumatic Brain Injury Compared with Other Induction Medications, a Retrospective Study
Austin Peters, Riley Mitchell, Stephen R. Wisniewski, Eva V. Zadorozny, Bryan A. Cotton, Jeremy W. Cannon, Martin A. Schreiber, Ernest E. Moore, Nicholas Namias, Joseph P. Minei, Jason L. Sperry, Bedda L. Rosario-Rivera, Francis X. Guyette
Neurotrauma Reports.2026;[Epub] CrossRef - Current Management and Future Challenges in the Management of Severe Traumatic Brain Injury
Larissa Russo, Aasim Kazmi, Nasim Ahmed
Medicina.2025; 61(4): 738. CrossRef - Analgesia, Sedation, and Neuromuscular Blockade in Pediatric Severe Traumatic Brain Injury: Secondary Analysis of the “Approaches and Decisions in Acute Pediatric TBI Trial” (ADAPT)
Jennifer Clancy Laws, Jaskaran Rakkar, Sandra D. W. Buttram, Michael Seth Wolf
Neurocritical Care.2025; 43(3): 745. CrossRef - ASN 2024 Annual Meeting Program Book and Abstracts
ASN Neuro.2025;[Epub] CrossRef - Study on the predictive role of bile acid and lymphocyte count in the prognosis of patients with traumatic brain injury: a retrospective analysis
Jie Xu, Yinghua Song, Xiancheng Chen, Ming Chen, Yun Zhao, Zhi Li, Songyang Li, Liang Zhang, Wenkui Yu
Frontiers in Neurology.2025;[Epub] CrossRef
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