Shekhar Aditya C, Nathanson Brian H, Mader Timothy J, Coute Ryan A
The Icahn School of Medicine at Mount Sinai New York NY USA.
OptiStatim, LLC Longmeadow MA USA.
J Am Heart Assoc. 2024 Feb 6;13(3):e031245. doi: 10.1161/JAHA.123.031245. Epub 2024 Jan 31.
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.
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%, =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%, <0.001).
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.
鉴于药物过量相关死亡率的上升，人们对更好地了解院外心脏骤停（OHCA）中的药物过量情况很感兴趣。对药物过量所致OHCA和非药物过量所致OHCA进行比较，将为公共卫生措施提供依据。
我们分析了2017年至2021年心脏骤停注册登记以提高生存率（CARES）的数据，比较了药物过量所致OHCA（OD-OHCA）与其他非创伤性原因导致的OHCA（非OD-OHCA）。排除涉及18岁以下患者、医疗机构住院患者、癌症诊断患者以及有特定缺失数据的患者。我们感兴趣的主要结局是具有良好神经功能结局的存活，定义为脑功能分类评分1或2。在一个有537100条记录的数据集中，29500例OD-OHCA病例和338073例非OD-OHCA病例符合纳入标准。OD-OHCA病例涉及的患者较年轻，合并症较少，较少可能被目击，且较少可能出现可电击心律。OD-OHCA队列中未调整的出院时脑功能分类评分=1或2的存活率显著更高（OD：15.2%对非OD：6.9%）。调整后的结果显示，当首次监测到的心脏骤停心律为可电击心律时，脑功能分类评分=1或2的存活率相当（OD：28.9%对非OD：23.5%，P=0.087），但当首次监测到的心脏骤停心律为不可电击心律时，OD-OHCA的脑功能分类评分=1或2的存活率显著更高（OD：9.6%对非OD：3.1%，P<0.001）。
在出现不可电击心律的患者中，OD-OHCA的结局明显更好。进一步的研究应探索心脏骤停的原因，公共卫生工作应努力减轻药物过量造成的负担。
