Abstract 317: Outcome Predictors in Substance - Related Cardiac Arrests

Abstract

Introduction: The incidence of substance-related cardiac arrests (SRCA) has increased due to the opioid epidemic. Previous studies have shown that SRCA present differently than non-SRCA. Weinvestigated differences in the clinical courses between the two groups for patients who were initially comatose post-resuscitation. Methods: Data from out-of-hospital arrest patients seen between 2007-2019 were retrospectively analyzed. Arrests were classified as SRCA if the patient had a positive toxicology screen, witnesses testified to substance use, or drug paraphernalia was present at the scene. Arrest types were categorized as shockable or non-shockable. Cerebral edema classifications were based on MRI or CT radiology reports. Poor outcomes were defined as Cerebral Performance Category (CPC) > 3 at discharge. Differences in demographics, presentation and outcomes were compared (Fisher’s Exact Test or Exact Wilcoxon-Mann-Whitney). Multivariable backward stepwise logistic regression was performed. Results: SRCA patients (N=90) were younger (p<.001), more likely to be non-shockable (p<.001) and have worse Glasgow Coma Scale (GCS) scores (p=.041) and higher Incidence (p<.001) and earlier development of cerebral edema (p=.04) than non-SRCA patients (N=339) (see Table). Adjusting for age and sex, SRCA was a significant predictor of GCS (p=0.02), shockable rhythm (p<.001), edema (p=.004) and poor outcomes (p=.016). SRCA (p<.001) remained an independent predictor of shockable rhythm in multivariable regression including sex (p<.001) and GCS (p=.006). Multivariable analyses showed younger age (p=.001) and non-shockable rhythm (p=.002) to be predictors of edema development. Older age (p=.002) and edema (p<.001) remained significant predictors of poor outcomes. Discussion: SRCA patients are more likely to have non-shockable arrests which in turn leads to cerebral edema development and potentially worse outcomes.