Department of Emergency Medicine, University Health Network, ON, Toronto, Canada.
Division of Clinical Pharmacology and Toxicology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
CJEM. 2022 Sep;24(6):650-658. doi: 10.1007/s43678-022-00326-9. Epub 2022 Jun 7.
There are conflicting recommendations for lay rescuer management of patients who are unresponsive and apneic due to opioid overdose. We evaluated the management of such patients at an urban supervised consumption site.
At a single urban supervised consumption site in Vancouver, BC, we conducted a retrospective chart review and administrative database linkage of consecutive patients who were unresponsive and apneic following witnessed opioid overdose between January 1, 2012 and December 31, 2017. We linked these visits with regional hospital records to define the entire care episode, which concluded when the patient was discharged from the supervised consumption site, ED, or hospital, or died. The primary outcome was successful resuscitation, defined as alive and neurologically intact (ambulatory and speaking coherently, or alert and oriented, or Glasgow Coma Scale 15) at the conclusion of the care episode. Secondary outcomes included mortality and predefined complications of resuscitation.
We collected 767 patients, with a median age of 43 and 81.6% male, with complete follow-up on 763 patients (99.5%). All patients were managed with oxygen and ventilation (100%, 95% CI 0.995-1.0); 715 (93.2%, 95% CI 0.911-0.949) received naloxone; no patients underwent chest compressions (0%, 95% CI 0-0.005). All patients with complete follow-up were alive and neurologically intact at the end of their care episode (100%, 95% CI 0.994-1.0). Overall, 191 (24.9%) patients were transported to hospital, and 15 (2.0%) patients required additional naloxone after leaving the supervised consumption site; 16 (2.1%) developed complications, and 1 patient was admitted to hospital.
At an urban supervised consumption site, all unresponsive, apneic patients with witnessed opioid overdose were successfully resuscitated with oxygen and/or naloxone. No patients required chest compressions.
对于因阿片类药物过量而导致无反应性和呼吸暂停的非专业急救人员，存在相互矛盾的推荐处理方法。我们评估了在城市监督使用场所中对这类患者的处理方法。
在不列颠哥伦比亚省温哥华的一个单一城市监督使用场所，我们对 2012 年 1 月 1 日至 2017 年 12 月 31 日期间，因目击阿片类药物过量而导致无反应性和呼吸暂停的连续患者进行了回顾性图表审查和行政数据库链接。我们将这些就诊与区域医院记录联系起来，以确定整个护理阶段，当患者从监督使用场所、急症室或医院出院或死亡时，该阶段结束。主要结局是成功复苏，定义为在护理阶段结束时存活且神经功能完整（能走动且言语清晰，或意识清醒且定向正常，或格拉斯哥昏迷量表评分为 15）。次要结局包括死亡率和复苏的预定义并发症。
我们共收集了 767 名患者，中位年龄为 43 岁，81.6%为男性，对 763 名患者（99.5%）进行了完整随访。所有患者均接受氧气和通气治疗（100%，95%置信区间 0.995-1.0）；715 名患者（93.2%，95%置信区间 0.911-0.949）接受了纳洛酮；没有患者进行胸外按压（0%，95%置信区间 0-0.005）。所有接受完整随访的患者在护理阶段结束时均存活且神经功能完整（100%，95%置信区间 0.994-1.0）。总体而言，191 名患者（24.9%）被转运至医院，15 名患者（2.0%）离开监督使用场所后需要额外的纳洛酮；16 名患者（2.1%）出现并发症，1 名患者住院。
在城市监督使用场所，所有因目击阿片类药物过量而导致无反应性和呼吸暂停的患者均通过氧气和/或纳洛酮成功复苏。没有患者需要进行胸外按压。
