Trends and outcomes of opioid-related cardiac arrest in a contemporary US population

Abstract

BackgroundOpioid abuse is a worldwide public health issue, and deaths related to opioid abuse are increasing. We aimed to investigate trends, predictors, and outcomes of cardiac arrest in patients with opioid abuse. MethodsAll hospitalizations for primary diagnosis of cardiac arrest between 2012 and 2018 identified in the Nationwide Inpatient Sample were categorized into those with or without a secondary diagnosis of opioid overdose. Multivariable logistic regression was used to analyze in-hospital outcomes of opioid-associated cardiac arrest after adjusting for patient and hospital characteristics. ResultsAmong 1,410,475 hospitalizations with cardiac arrest, opiate abuse as a secondary diagnosis was found in 3.1% (n=43,090) of hospitalizations, with an increasing trend during the study period. Hospitalizations for cardiac arrest with opioid abuse were seen less likely in patients with heart failure (21.2% vs. 40.6%; p<0.05), diabetes mellitus (19.5% vs. 35.4%; p<0.05), hypertension (43.4% vs. 64.9%; p<0.05) and renal failure (14.3% vs. 30.2%; p<0.05) and more frequently in those with history of alcohol abuse (16.9% vs. 7.1%; p<0.05), depression (18.8% vs. 9%; p<0.05), and smoking (37.0% vs. 21.8%; p<0.05) as compared with cardiac arrest without opioid use. In-hospital mortality in cardiac arrest patients with and without opioids was not different after multivariable adjustment (odds ratio OR 0.96, 0.91-1.00; p=0.07). OA-OHCA was associated with significantly higher risks of acute kidney injury, acute respiratory failure, and mechanical ventilation, p<0.05 for all. ConclusionOpioid abuse remains a significant cause of cardiac arrest. Despite similar in-hospital mortality and lower resource utilization, severe complications are more frequent in opioid abuse related cardiac arrests compared to those without opioid abuse.