Top Things to Know: Opioid-Associated Out-of-Hospital Cardiac Arrest
Prepared by Paul St. Laurent, DNP, RN, Sr. Science and Medicine Advisor, Lead
- The ongoing United States (US) opioid epidemic and associated opioid use disorder (OUD) is a significant cause of morbidity and mortality among adults 25-64 years.
- Opioid-associated out-of-hospital cardiac arrest, OA-OHCA, is the most dramatic manifestation of opioid use disorder (OUD).
- The epidemiology of OA-OHCA in the US is changing rapidly, with exponential increases in death from synthetic opioids and increases in heroin deaths that have offset the modest reductions in deaths from prescription opioids.
- OA-OHCA is distinct from other forms of OHCA with respect to pathophysiology and demographic manifestations.
- OA-OHCA is more likely to occur at home or in a private setting and less likely to be witnessed and receive bystander CPR. Thus, emergency management requires recognition of distress by the lay public or emergency dispatchers, a prompt emergency response, and effective ventilation and compressions.
- Optimizing outcomes after OA-OHCA requires responders to: (1) identify opioid-related poisoning as a health emergency and get appropriate help, (2) provide interventions to prevent the deterioration of respiratory depression to cardiac arrest, and (3) provide interventions to improve survival from OA-OHCA.
- Naloxone, an opioid antagonist, rapidly and effectively reverses respiratory depression induced by opioids and can be administered by emergency medical personnel, trained laypersons, and the general public with dispatcher instruction, to prevent cardiac arrest.
- Given the potential for delayed clearance of intoxicants after OA-OHCA, a stepwise approach to prognostication, in most cases, should delay decisions about withdrawal of life-sustaining therapy until: 1) at least 72 hours after return of spontaneous circulation and normothermia; 2) initial intoxicants and their metabolites have cleared; and 3) ICU-administered sedatives and analgesics have cleared.
- Targeted educational campaigns providing opioid education and naloxone distribution and conventional CPR training to those likely to suffer or witness an opioid overdose can prevent and optimally treat cases of OA-OHCA.
- Along with broader public education, legal reforms and policy aimed at preventing OA-OHCA can save lives and provide links to medication treatment and recovery of a generally young and otherwise healthy segment of the population.
Citation
Dezfulian C, Orkin AM, Maron BA, Elmer J, Girotra S, Gladwin MT, Merchant RM, Panchal AR, Perman SM, Starks MA, van Diepen S, Lavonas EJ; on behalf of the American Heart Association Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; Council on Quality of Care and Outcomes Research; and Council on Clinical Cardiology. Opioid-associated out-of-hospital cardiac arrest: distinctive clinical features and implications for health care and public responses: a scientific statement from the American Heart Association [published online ahead of print March 8, 2021]. Circulation. 2021;143:e•••–e•••. doi: 10.1161/CIR.0000000000000958