Comparing Intubation Rates in Patients Receiving Parenteral Olanzapine With and Without a Parenteral Benzodiazepine in the Emergency Department - 15/06/24

Doi : 10.1016/j.annemergmed.2024.05.006

Jon B. Cole, MD ^a,^b,^⁎ , Jamie L. Stang, MD ^a,^b, Jacob D. Collins, DO ^a, Lauren R. Klein, MD, MS ^a, Paige A. DeVries, DO ^a,^c, Jennifer Smith, MD ^d, Lesley C. Pepin, MD ^a,^b, Ryan T. Fuchs, MD ^a,^b, Brian E. Driver, MD ^a,^b
^a Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, MN
^b Department of Emergency Medicine, University of Minnesota Medical School, Minneapolis, MN
^c Kansas City University College of Osteopathic Medicine, Kansas City, MO
^d University of Minnesota, Minneapolis, MN

^∗Corresponding Author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Saturday 15 June 2024

Abstract

Study objective

United States prescribing information recommends against coadministration of injectable olanzapine with injectable benzodiazepines due to a risk of cardiorespiratory depression, whereas European prescribing information recommends the 2 drugs not be administered within 60 minutes of each other. In contrast, a recently published American College of Emergency Physicians clinical policy recommends injectable olanzapine and benzodiazepines be coadministered for treating severe agitation. We sought to compare injectable olanzapine with and without injectable benzodiazepines for evidence of cardiorespiratory depression.

Methods

We performed a retrospective study of patients in an urban emergency department from January 2017 through November 2019 who received parenteral olanzapine with or without parenteral benzodiazepines. We included patients receiving 2 total medication doses, either olanzapine+benzodiazepine or 2 doses of olanzapine, coadministered within 60 minutes. The primary outcome was tracheal intubation in the emergency department. Secondary outcomes included hypotension (systolic blood pressure less than 90 mmHg) and hypoxemia (SpO₂ less than 90%).

Results

We identified 693 patients (median [alcohol]=210 mg/dL, median age=37 years [IQR 29 to 49]). In total, 549 received 2 doses of olanzapine, and 144 patients received olanzapine and a benzodiazepine. We found no difference in intubation rates between the olanzapine-only group (21/549, 3.8%) and the olanzapine+benzodiazepine group (5/144, 3.5%; difference=0.3%, 95% confidence interval −3.0% to 3.7%). Rates of hypoxemia (2% olanzapine-only and 3% olanzapine+benzodiazepine) and hypotension (9% both groups) also were not different between groups.

Conclusion

We found no difference in cardiorespiratory depression between patients receiving only olanzapine versus olanzapine plus a benzodiazepine.

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Plan

Introduction

Background

Importance

Goals of Investigation

Materials and Methods

Study Design and Setting

Selection of Patients

Characteristics of Study Participants

	Please see page XX for the Editor’s Capsule Summary of this article.
	Supervising editor: Steven M. Green, MD. Specific detailed information about possible conflict of interest for individual editors is available at editors.
	Author contributions: JBC, JLS, LRK, PAD, and BED conceived and designed the study. JBC, LRK, and BED and supervised the conduct of the study and data collection. BED and LRK provided statistical advice on study design. BED and JBC analyzed the data. JLS, JDC, PAD, and JS collected data. JBC drafted the manuscript, and all authors contributed substantially to its revision. JBC takes responsibility for the paper as a whole.
	Data sharing statement: Data available: Yes. Data types: Deidentified participant data. How to access data: brian.driver@hcmed.org. When available: beginning date: 01-01-2017 through 05-31-2019. Who can access the data: Researchers whose proposed use of the data has been approved. Types of analyses: The data will be shared with researchers testing a hypothesis outlined in an institutional review board approved protocol.
	All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
	Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). This project did not receive external funding. The authors have stated that no such relationships exist.
	Presentation information: This work was accepted for presentation at the 2020 Society for Academic Emergency Medicine meeting in Denver, CO, USA, (abstract #501). Due to COVID-19, we were unable to present these data at the meeting; however, the abstract appeared in the meeting booklet.