Abstract 52: CPR Quality and Outcomes in Resuscitation of Suspected Drug-Related Cardiac Arrests

Abstract

Introduction: Cardiac arrest resulting from drug overdose (OD) is a significant public health issue and is the cause of many preventable deaths each year. Little is known about actual resuscitation process parameters of ODs and such arrests are often excluded from out-of-hospital cardiac arrest (OHCA) studies. We sought to investigate the characteristics of emergency medical services (EMS)-treated OHCA cases resulting from suspected OD. Methods: The University of Pittsburgh Institutional Review Board approved this study. Data from EMS-treated non-traumatic OHCAs were obtained from the Pittsburgh site of the Resuscitation Outcomes Consortium, a multi-center clinical research consortium with 10 sites across North America. Cases from 2006-2011 were analyzed. Case definition for OD was naloxone administration or drug overdose indicated on the patient care report. Resuscitation parameters including chest compression fraction, compression rate, and compression depth, shock delivery and the administration of resuscitation drugs were collected and compared between OD and non-OD groups. Demographic and outcome variables including age, sex, EMS- or bystander-witnessed status, return of spontaneous circulation and survival to hospital discharge were also compared by OD status. Resuscitation parameters were compared between groups using logistic regression or t-tests with alpha = 0.05. Results: We identified 180 OD cases and compared them to 2,162 non-OD OHCAs. Both groups were predominantly male (OD: 66%, non-OD: 59%; p = 0.0498). OD OHCAs were on average 20 years younger than non-OD OHCAs (45 vs. 65 years, p < 0.001). OD cases were associated with higher overall CPR fraction than non-OD (66% vs. 63%, p = 0.0158) and survival (19%, vs.11%; OR: 1.82, CI: 1.12 - 2.94, p = 0.015). OD cases were also associated with higher probability of epinephrine (OR: 2.05, CI: 1.33 - 3.15, p < 0.001) and sodium bicarbonate administration (OR: 2.70, CI: 1.98 - 3.68, p < 0.001). Other variables did not differ. Conclusion: Patients with OD-related OHCA were more likely to receive resuscitation drugs, receive higher CPR fraction, and survive than non-OD OHCAs.