RCT · 2026
Pilot trial tests whether a ketamine study is feasible for teens in the emergency department
- Original title
- A pilot randomized trial of ketamine for suicidal ideation in a pediatric emergency department.
- Authors
- Onikashvili Y, Burt H, Meckler G, et al.
- Journal
- CJEM, 2026
- Molecules
- Ketamine
- Conditions
- Suicidal ideation
- Participants
- 15
- Evidence grade
- Very low
- Source
- Read the original paper
The question
Is it practical and safe to run a randomized trial of intravenous ketamine for adolescents who come to an emergency department with suicidal thoughts?
What they did
Researchers ran a three-arm, triple-blinded randomized trial in a pediatric emergency department. Adolescents who needed hospital admission for suicidal thoughts were randomly assigned to receive intravenous ketamine (0.5 mg/kg), midazolam, a sedative (0.03 mg/kg), or saline (salt water, a placebo). The main outcome was simply how many eligible families agreed to take part. Suicidal thinking was also rated 90 minutes after the infusion using three different scales.
What they found
Of 21 eligible patients and guardians approached, 15 (71%, 95% confidence interval 48% to 87%) agreed to take part. Retention was 93% at 7 days, 86% at 14 days, and 73% at both 21 and 28 days. No serious or unexpected adverse events occurred, and the blinding appeared to work reasonably well. At 90 minutes, median scores on the Columbia Suicide Severity Rating Scale questions were 0 for ketamine, 0 for midazolam and 3 for saline; depression item and 0-10 Likert scores overlapped substantially across the three groups.
The fine print
With only 15 participants, this study was not designed or powered to show whether ketamine reduces suicidal thoughts, and the score differences reported could easily be chance. Enrolment barriers included limited emergency department resources and no consenting parent being present. Follow-up ran to 28 days, and roughly a quarter of participants were lost by then. This summary is based on the abstract only.
What it means
The study suggests a larger trial of ketamine for adolescent suicidal thoughts in the emergency department could be run safely and that most families are willing to take part, but it does not tell us whether ketamine helps.
Evidence grade: Very low. A randomized trial, but a very small pilot (15 participants) designed to test feasibility rather than to measure whether ketamine works.
This summary is based on the study’s published abstract.