Article

Out-of-hospital Care of Critical Drug Overdoses Involving Cardiac Arrest

Department of Medicine, University of Washington, Seattle, WA, USA.
Academic Emergency Medicine (Impact Factor: 2.2). 02/2004; 11(1):71-4. DOI: 10.1197/j.aem.2003.08.014
Source: PubMed

ABSTRACT Death from acute drug poisoning, also termed drug overdose, is a substantial public health problem. Little is known regarding the role of emergency medical services (EMS) in critical drug poisonings. This study investigates the involvement and potential mortality benefit of EMS for critical drug poisonings, characterized by cardiovascular collapse requiring cardiopulmonary resuscitation (CPR).
The study population was composed of death events caused by acute drug poisoning, defined as poisoning deaths and deaths averted (persons successfully resuscitated from out-of-hospital cardiac arrest by EMS) in King County, Washington, during the year 2000.
Eleven persons were successfully resuscitated and 234 persons died from cardiac arrest caused by acute drug poisoning, for a total of 245 cardiac events. The EMS responded to 79.6% (195/245), attempted resuscitation in 34.7% (85/245), and successfully resuscitated 4.5% (11/245) of all events. Among the 85 persons for whom EMS attempted resuscitation, opioids, cocaine, and alcohol were the predominant drugs involved, although over half involved multiple drug classes. Among the 11 persons successfully resuscitated, return of circulation was achieved in six following EMS cardiopulmonary resuscitation alone, in one following CPR and defibrillation, and in the remaining four after additional advanced life support.
In this community, EMS was involved in the majority of acute drug poisonings characterized by cardiovascular collapse and may potentially lower total mortality by approximately 4.5%. The results show that, in some survivors, return of spontaneous circulation may be achieved with CPR alone, suggesting a different pathophysiology in drug poisoning compared with cardiac arrest due to heart disease.

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    • "Drug overdoses are frequently witnessed by members of drug use networks (Darke and Hall, 2003; Segeev et al., 2003; Tracy et al., 2005), creating the opportunity for those present to mitigate drug overdose mortality by intervening on behalf of overdose victims. For example, because drug overdose is frequently associated with respiratory or cardiac failure (Paredes et al., 2004), calling for emergency medical help may improve survival from drug overdose by facilitating the response of paramedics to overdose events. It has been shown that heroin overdose victims who received emergency medical care while still exhibiting pulse and blood pressure had survival rates greater than 90% (Sporer et al., 1996). "
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    • "The high survival rate (76%) reported in our cohort was in accordance with the general survival rate from 58% (15 of 26) in case reports of poisoned patients who benefited from ECLS [3-14,16,17,19]. The 5 of 7 (71%) survival rate we reported among patients with cardiac arrest was in contrast with the dramatically low survival rate of 7% and 4.5%, respectively, reported in overdoses involving cardiac arrest [29,30]. To our knowledge, no studies have reported the survival rate of patients with drug-induced cardiovascular shock apparently refractory to conventional treatment, limiting comparisons with our cohort. "
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