From the Research
Intramuscular midazolam is recommended as a first-line treatment for status epilepticus in the prehospital setting, based on the findings of the RAMPART trial. The study showed that 10 mg of intramuscular midazolam (for adults) was at least as effective as 4 mg of intravenous lorazepam in stopping seizures before arrival at the hospital 1. For children, the dose of midazolam was 5 mg for 13-40 kg, and 10 mg for >40 kg. Midazolam should be administered via autoinjector or intramuscular injection into the thigh. This approach is preferred due to its ease of administration and non-inferior efficacy compared to IV lorazepam. The rapid absorption of intramuscular midazolam, especially when given in the thigh, allows for quick seizure control without the need for intravenous access, which can be challenging in emergency situations.
Some key points to consider when administering midazolam in this context include:
- The importance of rapid administration, as delays in treatment can lead to worse outcomes 2
- The potential for midazolam to be effective via multiple routes of administration, including intranasal and buccal, although intramuscular administration is the most well-studied in this context 3
- The need for careful consideration of the potential risks and benefits of midazolam administration, including the risk of respiratory depression and other adverse effects 4
Overall, the use of intramuscular midazolam in the prehospital setting has the potential to significantly improve outcomes for patients with status epilepticus, and should be considered a key component of emergency medical treatment protocols 5.