רוקחות-פרמקולוגיה

Benzodiazepine given by paramedics is safe and effective for out-of-hospital status epilepticus

מתוך medicontext.co.il

WESTPORT, CT (Reuters Health) – The results of a randomized, controlled trial provide "clear evidence" that paramedics can safely administer intravenous benzodiazepines for out-of-hospital status epilepticus. The results also show that halting status epilepticus before arrival at the hospital improves patient outcome.

Dr. Brian K. Alldredge from San Francisco General Hospital and colleagues describe the trial, in which they compared lorazepam, diazepam and placebo for out-of-hospital status epilepticus, in the August 30th issue of The New England Journal of Medicine.

Of 205 adults with prolonged or repetitive seizures, paramedics administered 2 mg lorazepam to 66 patients, 5 mg diazepam to 68 patients and placebo to the remaining patients. All medications were given intravenously, with a second injection of the same agent administered on route to the hospital if needed.

Both lorazepam and diazepam resulted in a better short-term outcome than did placebo, with a trend favoring lorazepam over diazepam. Status epilepticus was halted on arrival at the hospital in 59.1% of lorazepam-treated subjects, 42.6% of diazepam-treated subjects and 21.1% of placebo-treated subjects (p = 0.001).

Patients in whom status epilepticus was halted before arrival were significantly less likely to require ICU care (32%) compared with patients in status epilepticus upon arrival (73%), regardless of treatment.

Rates of respiratory or circulatory complications were 10.6%, 10.3%, and 22.5% in the lorazepam, diazepam, and placebo groups, respectively (p=0.08). "This suggests that respiratory complications associated with prolonged seizures may be more pronounced than those caused by intravenous lorazepam and diazepam given at relatively low doses," the authors write.

"The results are clear and compelling," Dr. Terence D. Valenzuela of the University of Arizona in Tucson and Dr. Michael K. Copass of the University of Washington in Seattle write in an accompanying editorial.

"Trained paraprofessionals can extend physician-level care into the community, and thus reduce the delay in treatment for time-critical conditions," Dr.Valenzuela told Reuters Health.

Based on the findings, and because lorazepam is the preferred in-hospital treatment, Dr. Alldredge's team recommends this drug for out-of-hospital status epilepticus in adults.

N Engl J Med 2001;345:631-637,689-690.

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