Prehospital naloxone administration \u2013 what influences choice of dose and route of administration?

Ida Tylleskar,Anne-Cathrine Braarud,Lars Petter Bjørnsen,Fridtjof Heyerdahl,Linn Gjersing,Ola Dale,Arne Kristian Skulberg

doi:10.1186/s12873-020-00366-3

Abstract

BackgroundAmidst the ongoing opioid crisis there are debates regarding the optimal route of administration and dosages of naloxone. This applies both for lay people administration and emergency medical services, and in the development of new naloxone products.We examined the characteristics of naloxone administration, including predictors of dosages and multiple doses during patient treatment by emergency medical service staff in order to enlighten this debate.MethodsThis was a prospective observational study of patients administered naloxone by the Oslo City Center emergency medical service, Norway (2014–2018). Cases were linked to The National Cause of Death Registry. We investigated the route of administration and dosage of naloxone, clinical and demographic variables relating to initial naloxone dose and use of multiple naloxone doses and one-week mortality.ResultsOverall, 2215 cases were included, and the majority (91.9%) were administered intramuscular naloxone. Initial doses were 0.4 or 0.8 mg, and 15% of patients received multiple dosages. Unconscious patients or those in respiratory arrest were more likely to be treated with 0.8 mg naloxone and to receive multiple doses. The one-week mortality from drug-related deaths was 4.1 per 1000 episodes, with no deaths due to rebound opioid toxicity.ConclusionsIntramuscular naloxone doses of 0.4 and 0.8 mg were effective and safe in the treatment of opioid overdose in the prehospital setting. Emergency medical staff appear to titrate naloxone based on clinical presentation.

Highlights

Amidst the ongoing opioid crisis there are debates regarding the optimal route of administration and dosages of naloxone
Goal of this investigation We examined characteristics of naloxone administration among patients attended by the largest emergency medical services (EMS) in Norway between 2014 and 2018, including a) route of administration, b) dosage and c) number of doses administered at each EMS attendance
Between 2014 and 2018, 2215 cases were treated with naloxone by the Oslo City Center EMS (Fig. 1)

Summary

Methods

Study design This was a 5-year observational study of patients treated with naloxone by the Oslo City Center EMS. Patient age, place of attendance, and naloxone doses and their routes of administration were registered Clinical variables such as respiration rate (RR) and consciousness reported as a Glasgow Coma Scale (GCS) score, both before and after EMS treatment with naloxone, were recorded. In Model 1, the following explanatory variables were included: patient sex, patient age, GCS and respiration rate at presentation to the EMS and if the overdose was attended at the safe injection facility. In Model 2, the following explanatory variables were included: initial naloxone dose, patient sex, patient age, GCS and respiration rate at first evaluation and if the overdose occurred at the safe injection facility. To ensure that missing data were not deleted listwise in the logistic regression analysis, a category for missing responses for variables with incomplete recordings (no valid reports) was included

Results

Conclusions

Background

Discussion

Limitations and strengths

Conclusion