Recreational drug overdose-related cardiac arrests: Break on through to the other side

Abstract

Introduction The annual rate of recreational overdose (OD)-related death is increasing exponentially, making unintentional overdose the leading cause of injury-related death in America. Unfortunately, little attention in the resuscitation community has focused on the post-arrest care of this rapidly growing population. Methods We included patients presenting between January 2009 and February 2014 after out-of-hospital cardiac arrest (OHCA) and abstracted baseline clinical characteristics and neurological outcomes. We considered an arrest to be an OD OHCA if toxicology screens were positive and not explained by therapeutic medication administration or home medications; or if there was a history strongly suggestive of OD. We compared the baseline clinical characteristics and outcomes between the OD and non-OD cohorts. Results In total, 591 OHCA patients were admitted, of which 85 (14%) arrests were OD-related. OD OHCA patients were significantly younger, had fewer medical comorbdities, were more likely to present with non-shockable rhythms and had worse baseline neurological function. However, overall survival, neurological outcomes and length of stay did not vary between groups. OD OHCA patients who survived to discharge had a significantly higher rate of favorable discharge dispositions (83% of OD OHCA survivors discharged to home or acute rehabilitation vs 62% of non-OD OHCA (P=0.03)). Conclusion Patients who have suffered an OD OHCA make up a significant proportion of the overall OHCA population. Despite poor baseline prognostic factors, survival after OD OHCA was no worse than after non-OD OHCA, and among survivors a majority had a good neurological outcome.

Out-of-hospital cardiac arrest survival in drug-related versus cardiac causes in Ontario: A retrospective cohort study

“…[11,12,13,35] When compared to the 2014 study by Koller et al and the 2016 study by Salcido et al , we found lower rates of survival among drug-related cardiac arrest patients (9.5% vs. 18.9% and 12.7% respectively). [11,12] In comparison with our findings, patient’s with opioid-related cardiac arrest in the Koller study had a much higher rate of witnessed arrests (48.4% vs. 27.5%) and initial shockable cardiac rhythms (15.6% vs. 7.78%).…”

The influences of Morphine or Ketamine pre-treatment on hemodynamic, acid-base status, biochemical markers of brain damage and early survival in rats after asphyxial cardiac arrest

“…We were not able to find any publications looking at pre-treatment with Morphine and survival rate in animals after cardiac arrest. However, two recent retrospective studies demonstrated that patients who were treated with opioids before or during CA had a statistically significantly higher survival rate [37] and much better neurological outcome [38] compared to untreated patients.…”

The influences of Morphine or Ketamine pre-treatment on hemodynamic, acid-base status, biochemical markers of brain damage and early survival in rats after asphyxial cardiac arrest

“…We were not able to find any publications looking at pre-treatment with Morphine and survival rate in animals after cardiac arrest. However, two recent retrospective studies demonstrated that patients who were treated with opioids before or during CA had a statistically significantly higher survival rate [36] and much better neurological outcome [37] compared to untreated patients.…”