UMEM Educational Pearls

Title: Safety of Droperidol use for agitation in the emergency department

Keywords: droperidol, agitation, sedation, QT prolongation (PubMed Search)

Posted: 12/5/2019 by Hong Kim, MD, MPH
Click here to contact Hong Kim, MD, MPH

After many years of national shortage and FDA’s black box warning in 2001 (QT prolongation) droperidol is slowing becoming available.

In 2015, a prospective observational study was published involving ED patients who received droperidol for agitation (acute behavioral disturbance).

Method

Study period: August 2009 to April 2013 in 6 EDs in Australia
Intervention: droperidol 10 – 20 mg IM or IV (if available)
EKG performed within 2 hours of droperidol administration.
QT was manually measured and plotted against the heart rate on the QT nomogram – if above “at-risk line” = abnormal

Results

Droperidol was administered in 1,403 ED patients
EKG available in 1,009 ED patients
Median age: 34 years (IQR: 25-44)
Men: 59.9%

Four leading reason for ED presentation

Alcohol intoxication: 421
Deliberate or threatened self-harm: 200
Psychostimulant use: 130
Mental illness/psychosis: 142

Median droperidol dose: 10 mg (IQR: 10 to 17.5 mg)
Abnormal QT interval: 13 (1.3%, 95% CI: 0.3% to 2.3%)
- 7 patient had other potential contributing factors: methadone, escitalopram, Amiodarone or preexisting condition.
Median time to sedation: 20 min (IQR: 10 to 30 min)

Adverse events

Desaturation (<90%): 22 (1.6%)
Airway obstruction: 8 (0.6%)
Hypotension: 28 (2.0%)
Extrapyramidal symptoms: 7 (0.5%)
Arrhythmia: 1 (0.1%)
Hypoventilation (RR < 12 breaths/min): 4 (0.2%)
Seizure: 1 (0.1%)
No adverse events: 1,333 (95.0%)

Conclusion

Droperidol is a safe sedating agent with no evidence of increased risk for QT prolongation with the doses used.

References

Calver L et al. The safety and effectivenss of droperidol for sedation of acute behavioral disturbance in the emergency department. Ann Emerg Med. 2015;66:230-238.