Cardiac Arrest Following Drug Overdose in the United States: An Analysis of the Cardiac Arrest Registry to Enhance Survival
Background Given increases in drug overdose‐associated mortality, there is interest in better understanding of drug overdose out‐of‐hospital cardiac arrest (OHCA). A comparison between overdose‐attributable OHCA and nonoverdose‐attributable OHCA will inform public health measures. Methods and Result...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2024-02-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.031245 |
| _version_ | 1827342090786308096 |
|---|---|
| author | Aditya C. Shekhar Brian H. Nathanson Timothy J. Mader Ryan A. Coute |
| author_facet | Aditya C. Shekhar Brian H. Nathanson Timothy J. Mader Ryan A. Coute |
| author_sort | Aditya C. Shekhar |
| collection | DOAJ |
| description | Background Given increases in drug overdose‐associated mortality, there is interest in better understanding of drug overdose out‐of‐hospital cardiac arrest (OHCA). A comparison between overdose‐attributable OHCA and nonoverdose‐attributable OHCA will inform public health measures. Methods and Results We analyzed data from 2017 to 2021 in the Cardiac Arrest Registry to Enhance Survival (CARES), comparing overdose‐attributable OHCA (OD‐OHCA) with OHCA from other nontraumatic causes (non‐OD‐OHCA). Arrests involving patients <18 years, health care facility residents, patients with cancer diagnoses, and patients with select missing data were excluded. Our main outcome of interest was survival with good neurological outcome, defined as Cerebral Performance Category score 1 or 2. From a data set with 537 100 entries, 29 500 OD‐OHCA cases and 338 073 non‐OD‐OHCA cases met inclusion criteria. OD‐OHCA cases involved younger patients with fewer comorbidities, were less likely to be witnessed, and less likely to present with a shockable rhythm. Unadjusted survival to hospital discharge with Cerebral Performance Category score =1 or 2 was significantly higher in the OD‐OHCA cohort (OD: 15.2% versus non‐OD: 6.9%). Adjusted results showed comparable survival with Cerebral Performance Category score =1 or 2 when the first monitored arrest rhythm was shockable (OD: 28.9% versus non‐OD: 23.5%, P=0.087) but significantly higher survival rates with Cerebral Performance Category score =1 or 2 for OD‐OHCA when the first monitored arrest rhythm was nonshockable (OD: 9.6% versus non‐OD: 3.1%, P<0.001). Conclusions Among patients presenting with nonshockable rhythms, OD‐OHCA is associated with significantly better outcomes. Further research should explore cardiac arrest causes, and public health efforts should attempt to reduce the burden from drug overdoses. |
| first_indexed | 2024-03-07T22:02:41Z |
| format | Article |
| id | doaj.art-d902c8a67c084478a3b4bd6c7bbc4aae |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-07T22:02:41Z |
| publishDate | 2024-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-d902c8a67c084478a3b4bd6c7bbc4aae2024-02-24T04:06:35ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-02-0113310.1161/JAHA.123.031245Cardiac Arrest Following Drug Overdose in the United States: An Analysis of the Cardiac Arrest Registry to Enhance SurvivalAditya C. Shekhar0Brian H. Nathanson1Timothy J. Mader2Ryan A. Coute3The Icahn School of Medicine at Mount Sinai New York NY USAOptiStatim, LLC Longmeadow MA USADepartment of Emergency Medicine UMass Chan Medical School—Baystate Springfield MA USADepartment of Emergency Medicine University of Alabama at Birmingham Heersink School of Medicine Birmingham AL USABackground Given increases in drug overdose‐associated mortality, there is interest in better understanding of drug overdose out‐of‐hospital cardiac arrest (OHCA). A comparison between overdose‐attributable OHCA and nonoverdose‐attributable OHCA will inform public health measures. Methods and Results We analyzed data from 2017 to 2021 in the Cardiac Arrest Registry to Enhance Survival (CARES), comparing overdose‐attributable OHCA (OD‐OHCA) with OHCA from other nontraumatic causes (non‐OD‐OHCA). Arrests involving patients <18 years, health care facility residents, patients with cancer diagnoses, and patients with select missing data were excluded. Our main outcome of interest was survival with good neurological outcome, defined as Cerebral Performance Category score 1 or 2. From a data set with 537 100 entries, 29 500 OD‐OHCA cases and 338 073 non‐OD‐OHCA cases met inclusion criteria. OD‐OHCA cases involved younger patients with fewer comorbidities, were less likely to be witnessed, and less likely to present with a shockable rhythm. Unadjusted survival to hospital discharge with Cerebral Performance Category score =1 or 2 was significantly higher in the OD‐OHCA cohort (OD: 15.2% versus non‐OD: 6.9%). Adjusted results showed comparable survival with Cerebral Performance Category score =1 or 2 when the first monitored arrest rhythm was shockable (OD: 28.9% versus non‐OD: 23.5%, P=0.087) but significantly higher survival rates with Cerebral Performance Category score =1 or 2 for OD‐OHCA when the first monitored arrest rhythm was nonshockable (OD: 9.6% versus non‐OD: 3.1%, P<0.001). Conclusions Among patients presenting with nonshockable rhythms, OD‐OHCA is associated with significantly better outcomes. Further research should explore cardiac arrest causes, and public health efforts should attempt to reduce the burden from drug overdoses.https://www.ahajournals.org/doi/10.1161/JAHA.123.031245cardiac arrestdrug overdoseout‐of‐hospital cardiac arrestprehospital carepublic health |
| spellingShingle | Aditya C. Shekhar Brian H. Nathanson Timothy J. Mader Ryan A. Coute Cardiac Arrest Following Drug Overdose in the United States: An Analysis of the Cardiac Arrest Registry to Enhance Survival Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiac arrest drug overdose out‐of‐hospital cardiac arrest prehospital care public health |
| title | Cardiac Arrest Following Drug Overdose in the United States: An Analysis of the Cardiac Arrest Registry to Enhance Survival |
| title_full | Cardiac Arrest Following Drug Overdose in the United States: An Analysis of the Cardiac Arrest Registry to Enhance Survival |
| title_fullStr | Cardiac Arrest Following Drug Overdose in the United States: An Analysis of the Cardiac Arrest Registry to Enhance Survival |
| title_full_unstemmed | Cardiac Arrest Following Drug Overdose in the United States: An Analysis of the Cardiac Arrest Registry to Enhance Survival |
| title_short | Cardiac Arrest Following Drug Overdose in the United States: An Analysis of the Cardiac Arrest Registry to Enhance Survival |
| title_sort | cardiac arrest following drug overdose in the united states an analysis of the cardiac arrest registry to enhance survival |
| topic | cardiac arrest drug overdose out‐of‐hospital cardiac arrest prehospital care public health |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.031245 |
| work_keys_str_mv | AT adityacshekhar cardiacarrestfollowingdrugoverdoseintheunitedstatesananalysisofthecardiacarrestregistrytoenhancesurvival AT brianhnathanson cardiacarrestfollowingdrugoverdoseintheunitedstatesananalysisofthecardiacarrestregistrytoenhancesurvival AT timothyjmader cardiacarrestfollowingdrugoverdoseintheunitedstatesananalysisofthecardiacarrestregistrytoenhancesurvival AT ryanacoute cardiacarrestfollowingdrugoverdoseintheunitedstatesananalysisofthecardiacarrestregistrytoenhancesurvival |