In out-of-hospital cardiac arrest, survival more likely if overdose-related
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Key takeaways:
- Many out-of-hospital cardiac arrests are due to drug overdose, according to registry data.
- Patients with overdose-related cardiac arrest tend to be younger and healthier vs. other cardiac arrest causes.
Adults who experience an out-of-hospital cardiac arrest are much more likely to survive to hospital discharge if the cause is overdose-related, with data also showing such patients tended to be younger and healthier, researchers reported.
“Out-of-hospital cardiac arrests due to drug overdoses are distinct from other types of cardiac arrests, such as those due to primary cardiac etiologies,” Aditya C. Shekhar, MBE, a medical student at the Icahn School of Medicine at Mount Sinai, told Healio. “Namely, we show that these arrests more often involve younger and healthier patients with fewer comorbidities, are less likely to be directly witnessed by someone else and are less likely to present with a shockable rhythm. Even after adjusting for these differences, we find overdose-attributable arrests are associated with dramatically improved outcomes compared with other arrest etiologies when the heart rhythm is non-shockable.”
Data were derived from Shekhar AC, et al. J Am Heart Assoc. 2024;doi:10.1161/JAHA.123.031245.
In a retrospective study, Shekhar and colleagues analyzed data from all adult emergency medical service (EMS)-treated out-of-hospital cardiac arrests in the U.S. from 2017 to 2021, using the Cardiac Arrest Registry to Enhance Survival (CARES) database. Arrests that were documented as overdose-attributable (n = 29,500) were compared with arrests that were documented as attributable to other causes (n = 338,073). The primary outcome was survival to hospital discharge with good neurological status, defined as a Cerebral Performance Category (CPC) score of 1 or 2.
The findings were published in the Journal of the American Heart Association.
When comparing overdose-related cardiac arrests with cardiac arrests attributable to other causes, researchers found that patients with overdose-related cardiac arrests were younger (mean age, 39 years vs. 64 years; P < .001) and had fewer comorbidities including diabetes, hypertension, renal disease, heart disease, respiratory disease and stroke. Additionally, overdose-related cardiac arrests were much less likely to be witnessed compared with cardiac arrests attributable to other causes (21.7% vs. 46.1%; P < .001). Overdose-related arrests also had lower rates of shockable first monitored arrest rhythms vs. cardiac arrests attributable to other causes (5.1% vs. 20.9%; P < .001).
“A major implication of our study is that a significant number of cardiac arrests are due to drug overdose and that ample public health and prevention work remains,” Shekhar told Healio. “Another clinical implication is that different cardiac arrest etiologies may require distinct strategies of prognostication and perhaps even treatment.”
In unadjusted analyses, researchers found that overall outcomes were significantly better for patients with an overdose-related cardiac arrest compared with those who had a cardiac arrest attributable to other causes, including survival with favorable neurological outcomes, defined as a CPC score or 1 or 2 (15.2% vs. 6.9%; P < .001). However, in adjusted analyses, researchers found that neurological outcomes were similar between overdose-related and non-overdose-related out-of-hospital cardiac arrests when the first monitored rhythm was shockable, but patients with overdose-related cardiac arrest had higher rates of survival with a CPC score of 1 or 2 when the first monitored arrest rhythm was non-shockable (9.6% vs. 3.1%; P < .001).
“A big open question from our study is why might cardiac arrests due to overdose have such better outcomes when the initial rhythm is non-shockable?” Shakhar told Healio. “One hypothesis that we discuss briefly is that certain drugs may actually hold some neuroprotective properties that allow the brain to survive with minimal perfusion for longer than expected. Another area for further research involves how the COVID-19 pandemic might have altered trends in overdoses and overdose-attributable cardiac arrest.”
For more information:
Aditya C. Shekhar, MBE, can be reached at aditya.shekhar@icahn.mssm.edu.
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