Salcido David D, Torres Cesar, Koller Allison C, Orkin Aaron M, Schmicker Robert H, Morrison Laurie J, Nichol Graham, Stephens Shannon, Menegazzi James J
University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
University of Washington, Seattle, WA, United States.
Resuscitation. 2016 Feb;99:13-9. doi: 10.1016/j.resuscitation.2015.11.010. Epub 2015 Nov 27.
The frequency of lethal overdose due to prescription and non-prescription drugs is increasing in North America. The aim of this study was to estimate overall and regional variation in incidence and outcomes of out-of-hospital cardiac arrest due to overdose across North America.
We conducted a retrospective cohort study using case data for the period 2006-2010 from the Resuscitation Outcomes Consortium, a clinical research network with 10 regional clinical centers in United States and Canada. Cases of out-of-hospital cardiac arrest due to drug overdose were identified through review of data derived from prehospital clinical records. We calculated incidence of out-of-hospital cardiac arrest due to overdose per 100,000 person-years and proportion of the same among all out-of-hospital cardiac arrests. We analyzed the association between overdose cardiac arrest etiology and resuscitation outcomes.
Included were 56,272 cases, of which 1351 were due to overdose. Regional incidence of out-of-hospital cardiac arrest due to overdose varied between 0.5 and 2.7 per 100,000 person years (p<0.001), and proportion of the same among all treated out-of-hospital cardiac arrests ranged from 0.8% to 4.0%. Overdose cases were younger, less likely to be witnessed, and less likely to present with a shockable rhythm. Compared to non-overdose, overdose was directly associated with return of spontaneous circulation (OR: 1.55; 95% CI: 1.35-1.78) and survival (OR: 2.14; 95% CI: 1.72-2.65).
Overdose made up 2.4% of all out-of-hospital cardiac arrest, although incidence varied up to 5-fold across regions. Overdose cases were more likely to survive than non-overdose cases.
在北美，因处方药和非处方药导致的致命性过量用药频率正在上升。本研究的目的是估计北美地区因过量用药导致的院外心脏骤停的发病率及转归的总体和区域差异。
我们进行了一项回顾性队列研究，使用了复苏结局联盟2006 - 2010年期间的病例数据，该联盟是一个在美国和加拿大拥有10个区域临床中心的临床研究网络。通过审查院前临床记录中的数据来识别因药物过量导致的院外心脏骤停病例。我们计算了每10万人年因过量用药导致的院外心脏骤停的发病率以及其在所有院外心脏骤停中所占的比例。我们分析了过量用药心脏骤停病因与复苏转归之间的关联。
纳入了56272例病例，其中1351例是因过量用药导致的。因过量用药导致的院外心脏骤停的区域发病率在每10万人年0.5至2.7例之间（p<0.001），其在所有接受治疗的院外心脏骤停中所占比例在0.8%至4.0%之间。过量用药病例更年轻，较少有人目睹发病，且出现可电击心律的可能性较小。与非过量用药相比，过量用药与自主循环恢复直接相关（比值比：1.55；95%置信区间：1.35 - 1.78）以及生存相关（比值比：2.14；95%置信区间：1.72 - 2.65）。
过量用药占所有院外心脏骤停的2.4%，尽管各地区发病率差异高达5倍。过量用药病例比非过量用药病例更有可能存活。
