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
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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.