Regional incidence and outcome of out-of-hospital cardiac arrest associated with overdose

Abstract

Background The frequency of lethal overdose due to prescription and non-prescription drugs is increasing in North America. The aim of this study was to estimate overall and regional variation in incidence and outcomes of out-of-hospital cardiac arrest due to overdose across North America. Methods We conducted a retrospective cohort study using case data for the period 2006–2010 from the Resuscitation Outcomes Consortium, a clinical research network with 10 regional clinical centers in United States and Canada. Cases of out-of-hospital cardiac arrest due to drug overdose were identified through review of data derived from prehospital clinical records. We calculated incidence of out-of-hospital cardiac arrest due to overdose per 100,000 person-years and proportion of the same among all out-of-hospital cardiac arrests. We analyzed the association between overdose cardiac arrest etiology and resuscitation outcomes. Results Included were 56,272 cases, of which 1351 were due to overdose. Regional incidence of out-of-hospital cardiac arrest due to overdose varied between 0.5 and 2.7 per 100,000 person years (p < 0.001), and proportion of the same among all treated out-of-hospital cardiac arrests ranged from 0.8% to 4.0%. Overdose cases were younger, less likely to be witnessed, and less likely to present with a shockable rhythm. Compared to non-overdose, overdose was directly associated with return of spontaneous circulation (OR: 1.55; 95% CI: 1.35–1.78) and survival (OR: 2.14; 95% CI: 1.72–2.65). Conclusions Overdose made up 2.4% of all out-of-hospital cardiac arrest, although incidence varied up to 5-fold across regions. Overdose cases were more likely to survive than non-overdose cases.

The benefits of youth are lost on the young cardiac arrest patient

“…In older children (for example, adolescents) and young adults, OHCA is often unwitnessed as it is the result of suicide or substance abuse with overdose 12 , 13 , 15 – 17 . A recent report from the Resuscitation Outcomes Consortium (ROC) documents the fact that increasing overdose deaths tend to occur in young adults and tend to be unwitnessed 16 .…”

“…This is compared with incidences of approximately 24% shockable rhythm in adult OHCA 27 , 28 . Young adults, who tend to make up the majority of overdose-related OHCA, generally present with non-shockable rhythms 16 . Although it remains uncertain why asphyxial CA confers more severe outcomes, this observation has been consistently made in experimental comparisons of different forms of CA where insult time is matched 31 , 32 .…”

72-h therapeutic hypothermia improves neurological outcomes in paediatric asphyxial out-of-hospital cardiac arrest–An exploratory investigation

“…Despite advances in resuscitation for paediatric out-of-hospital cardiac arrest (OHCA), the patients who survive after resuscitation often suffer from severe neurological disabilities. Asphyxia is the most common cause of paediatric OHCA, and the aetiologies of asphyxial OHCA vary by age group [1][2][3][4][5][6][7][8][9]. In young infants, most deaths occur during sleep and are attributed to acute life-threatening events or suffocation [1,[3][4][5][6][7].…”

“…In young infants, most deaths occur during sleep and are attributed to acute life-threatening events or suffocation [1,[3][4][5][6][7]. In preschool-and early school-aged children, asphyxia is most commonly caused by drowning, choking, or suffocation [7], and in adolescents and young adults OHCA is often the result of suicide or substance abuse with an overdose [1,[3][4][5][6][7][8]. In addition, asphyxial cardiac arrest is known to result in more severe brain injuries than ventricular fibrillation cardiac arrest of the same duration [10,11].…”

Poisoning-induced Out-of-Hospital Cardiac Arrest and Outcomes according to Poison Agent

“…The incidence varies among continents, from 52.5 for Asia to 112.9 for Australia ( 1 ). OHCAs of non-cardiac etiology vary in their epidemiologic features, with different incidence rates and outcomes ( 2 3 4 ).…”