Jasti Jamie, Kennedy Kristopher, Colella M Riccardo, Aufderheide Tom P
Department of Emergency Medicine, Medical College of Wisconsin, 8701 W Watertown Plank Rd., Milwaukee, WI 53226, USA.
Resuscitation. 2025 Apr;209:110569. doi: 10.1016/j.resuscitation.2025.110569. Epub 2025 Mar 5.
Previous studies have used emergency medical services (EMS) naloxone administration and EMS overdose impression as surrogate markers to identify opioid-associated (OA) out-of-hospital cardiac arrests (OA-OHCA). We evaluated the accuracy of these two surrogate markers using medical examiner post-mortem toxicology data in OHCA patients who died.
We conducted a retrospective cohort study of all adult (≥18) non-traumatic OHCA patients treated by Milwaukee County EMS between January 1st, 2015 to December 31st, 2016. EMS naloxone administration and EMS impression of cardiac arrest etiology were used to classify expired patients into 2 groups: (1a) Received ≥1 Naloxone (1b) No Naloxone, and (2a) EMS-impression overdose, (2b) Not EMS-impression overdose. Milwaukee County Medical Examiner (MCME) opioid toxicology data was used as the reference standard and matched to EMS-treated OHCA patients that expired to determine the sensitivity (SN), specificity (SP), positive predictive value (PPV), and the negative predictive value (NPV) of both surrogate markers.
1,654 OHCA cases were included; 112 (6.8%) received ≥1 Naloxone and 1,542 (93.2%) received No Naloxone; 60 (3.6%) were EMS-impression overdose and 1,594 (96.4%) were not EMS-impression overdose. Of the 525 opioid-associated deaths in the MCME Drug-related Death Database, 150 (28.6%) were OA-OHCA cases treated by EMS. The SN, SP, PPV, and NPV for EMS naloxone administration was 39%, 96%, 52%, and 94% respectively. The SN, SP, PPV, and NPV for EMS-impression overdose was 27%, 99%, 68%, and 93% respectively.
EMS naloxone administration and EMS- impression overdose had limited sensitivity for identifying OA-OHCA in expired patients in this large urban EMS system. Prehospital and public health researchers should identify improved methods for accurately classifying this OHCA subpopulation.
以往研究将紧急医疗服务（EMS）给予纳洛酮以及EMS对过量用药的判断作为替代指标，以识别阿片类药物相关的院外心脏骤停（OA-OHCA）。我们利用法医尸检毒理学数据，评估了这两种替代指标在死亡的OHCA患者中的准确性。
我们对2015年1月1日至2016年12月31日期间由密尔沃基县EMS治疗的所有成年（≥18岁）非创伤性OHCA患者进行了一项回顾性队列研究。EMS给予纳洛酮以及EMS对心脏骤停病因的判断被用于将死亡患者分为两组：（1a）接受≥1次纳洛酮治疗（1b）未接受纳洛酮治疗，以及（2a）EMS判断为过量用药，（2b）非EMS判断为过量用药。密尔沃基县法医（MCME）的阿片类药物毒理学数据被用作参考标准，并与接受EMS治疗的死亡OHCA患者进行匹配，以确定这两种替代指标的敏感性（SN）、特异性（SP）、阳性预测值（PPV）和阴性预测值（NPV）。
纳入了1654例OHCA病例；112例（6.8%）接受了≥1次纳洛酮治疗，1542例（93.2%）未接受纳洛酮治疗；60例（3.6%）被EMS判断为过量用药，1594例（96.4%）非EMS判断为过量用药。在MCME药物相关死亡数据库中的525例阿片类药物相关死亡病例中，150例（28.6%）是由EMS治疗的OA-OHCA病例。EMS给予纳洛酮的SN、SP、PPV和NPV分别为39%、96%、52%和94%。EMS判断为过量用药的SN、SP、PPV和NPV分别为27%、99%、68%和93%。
在这个大型城市EMS系统中，EMS给予纳洛酮以及EMS判断为过量用药在识别死亡患者中的OA-OHCA方面敏感性有限。院前和公共卫生研究人员应确定更准确分类这一OHCA亚组的改进方法。
