Orkin Aaron M, Zhan Chun, Buick Jason E, Drennan Ian R, Klaiman Michelle, Leece Pamela, Morrison Laurie J
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
PLoS One. 2017 Apr 26;12(4):e0176441. doi: 10.1371/journal.pone.0176441. eCollection 2017.
Drug overdose causes approximately 183,000 deaths worldwide annually and 50,000 deaths in Canada and the United States combined. Drug-related deaths are concentrated among young people, leading to a substantial burden of disease and loss of potential life years. Understanding the epidemiology, patterns of care, and prognosis of drug-related prehospital emergencies may lead to improved outcomes.
We conducted a retrospective cohort study of out-of-hospital cardiac arrests with drug-related and presumed cardiac causes between 2007 and 2013 using the Toronto Regional RescuNet Epistry database. The primary outcome was survival to hospital discharge. We computed standardized case fatality rates, and odds ratios of survival to hospital discharge for cardiac arrests with drug-related versus presumed cardiac causes, adjusting for confounders using logistic regression.
The analysis involved 21,497 cardiac arrests, including 378 (1.8%) drug-related and 21,119 (98.2%) presumed cardiac. Compared with the presumed cardiac group, drug-related arrest patients were younger and less likely to receive bystander resuscitation, have initial shockable cardiac rhythms, or be transported to hospital. There were no significant differences in emergency medical service response times, return of spontaneous circulation, or survival to discharge. Standardized case fatality rates confirmed that these effects were not due to age or sex differences. Adjusting for known predictors of survival, drug-related cardiac arrest was associated with increased odds of survival to hospital discharge (OR1.44, 95%CI 1.15-1.81).
In out-of-hospital cardiac arrest, patients with drug-related causes are less likely than those with presumed cardiac causes to receive bystander resuscitation or have an initial shockable rhythm, but are more likely to survive after accounting for predictors of survival. The demographics and outcomes among drug-related cardiac arrest patients offers unique opportunities for prehospital intervention.
药物过量每年在全球导致约18.3万人死亡，在加拿大和美国合计导致5万人死亡。与药物相关的死亡集中在年轻人中，导致了巨大的疾病负担和潜在生命年的损失。了解与药物相关的院前急救的流行病学、护理模式和预后可能会改善结局。
我们使用多伦多地区救援网络病历数据库，对2007年至2013年间因药物相关和推测为心脏原因导致的院外心脏骤停进行了一项回顾性队列研究。主要结局是存活至出院。我们计算了标准化病死率，以及药物相关与推测为心脏原因导致的心脏骤停存活至出院的比值比，并使用逻辑回归对混杂因素进行调整。
分析涉及21497例心脏骤停，其中378例（1.8%）与药物相关，21119例（98.2%）推测为心脏原因。与推测为心脏原因的组相比，药物相关心脏骤停患者更年轻，接受旁观者心肺复苏、初始可电击心律或被送往医院的可能性更小。在紧急医疗服务响应时间、自主循环恢复或存活至出院方面没有显著差异。标准化病死率证实这些影响不是由于年龄或性别差异。在调整已知的存活预测因素后，药物相关心脏骤停与存活至出院的几率增加相关（比值比1.44，95%置信区间1.15-1.81）。
在院外心脏骤停中，与药物相关原因的患者比推测为心脏原因的患者接受旁观者心肺复苏或初始可电击心律的可能性更小，但在考虑存活预测因素后更有可能存活。药物相关心脏骤停患者的人口统计学特征和结局为院前干预提供了独特的机会。
