Mok Valerie, Haines Morgan, Nowroozpoor Armin, Yap Justin, Brebner Callahan, Asamoah-Boaheng Michael, Hutton Jacob, Scheuermeyer Frank, Sekhon Mypinder, Christenson Jim, Grunau Brian
British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada.
British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada.
Resuscitation. 2024 Sep;202:110313. doi: 10.1016/j.resuscitation.2024.110313. Epub 2024 Jul 10.
Clinicians may make prognostication decisions for out-of-hospital cardiac arrest (OHCA) using historical details pertaining to non-prescription drug use. However, differences in outcomes between OHCAs with evidence of non-prescription drug use, compared to other OHCAs, have not been well described.
We included emergency medical service-treated OHCA in the British Columbia Cardiac Arrest Registry (January/2019-June/2023). We classified cases as "non-prescription drug-associated cardiac arrests" (DA-OHCA) if there was evidence of non-prescription drug use preceding the OHCA, including witness accounts of use within 24 h or paraphernalia at the scene. We fit logistic regression models to investigate the association between DA-OHCA (vs. other cases) and favourable neurological outcome (Cerebral Performance Category [CPC] 1-2) and survival at hospital discharge, and return of spontaneous circulation (ROSC).
Of 18,426 OHCA, 2,171 (12%) were classified as DA-OHCA. DA-OHCA tended to be younger, unwitnessed, occur during the evening or night, and present with a non-shockable rhythm, compared to other OHCA. DA-OHCA (221 [10%]) had a greater proportion (difference 1.8%; 95% CI 0.49-3.2) with favourable neurological outcomes compared to other OHCA (1,365 [8.4%]). Adjusted models did not identify an association of DA-OHCA with favourable neurological outcome (OR 1.08, 95% CI 0.87-1.33) or survival to hospital discharge (OR 1.13, 95% CI 0.93-1.38), but did demonstrate an association with ROSC (OR 1.13, 95% CI 1.004-1.27).
In unadjusted models, DA-OHCA was associated with an improved odds of survival and favourable neurological outcomes at hospital discharge, compared to other OHCA. However, we did not detect an association in adjusted analyses.
临床医生可能会利用与非处方药使用相关的历史细节，对院外心脏骤停（OHCA）做出预后判断。然而，与其他OHCA相比，有非处方药使用证据的OHCA在预后方面的差异尚未得到充分描述。
我们纳入了不列颠哥伦比亚省心脏骤停登记处（2019年1月至2023年6月）中接受紧急医疗服务治疗的OHCA。如果在OHCA之前有非处方药使用的证据，包括在24小时内使用的证人陈述或现场的用具，我们将病例分类为“非处方药相关心脏骤停”（DA-OHCA）。我们拟合逻辑回归模型，以研究DA-OHCA（与其他病例相比）与良好神经功能预后（脑功能分类[CPC]1-2）、出院存活以及自主循环恢复（ROSC）之间的关联。
在18426例OHCA中，2171例（12%）被分类为DA-OHCA。与其他OHCA相比，DA-OHCA患者往往更年轻，未被目击，在傍晚或夜间发生，且呈现不可电击心律。与其他OHCA（1365例[8.4%]）相比，DA-OHCA（221例[10%]）有更高比例（差异1.8%；95%CI 0.49-3.2）的患者获得良好神经功能预后。校正模型未发现DA-OHCA与良好神经功能预后（OR 1.08，95%CI 0.87-1.33）或出院存活（OR 1.13，95%CI 0.93-1.38）之间存在关联，但确实显示与ROSC存在关联（OR 1.13，95%CI 1.004-1.27）。
在未校正模型中，与其他OHCA相比，DA-OHCA与出院时存活几率提高及良好神经功能预后相关。然而，我们在校正分析中未检测到关联。
