Prehospital midazolam use and outcomes among patients with out-of-hospital status epilepticus

Objective: To examine the use of benzodiazepines and the association between low benzodiazepine dose, breakthrough seizures, and respiratory support in patients with status epilepticus.
Methods: Cross-sectional analysis of adult patients with status epilepticus treated by an emergency medical services (EMS) agency from 2013 to 2018. The primary outcome was treatment with a second benzodiazepine dose, an indicator for breakthrough seizure. The secondary outcome was receiving respiratory support. Midazolam was the only benzodiazepine administered.
Results: Among 2,494 cases of status epilepticus, mean age was 54.0 years and 1,146 (46%) were female. There were 1,537 patients given midazolam at any dose, yielding an administration rate of 62%. No patients received a dose and route consistent with national guidelines. Rescue therapy with a second midazolam dose was required in 282 (18%) patients. Higher midazolam doses were associated with lower odds of rescue therapy (OR 0.8, 95% CI 0.7-0.9...