Out-of-hospital care of critical drug overdoses involving cardiac arrest.
OBJECTIVE
Death from acute drug poisoning, also termed drug overdose, is a substantial public health problem. Little is known regarding the role of emergency medical services (EMS) in critical drug poisonings. This study investigates the involvement and potential mortality benefit of EMS for critical drug poisonings, characterized by cardiovascular collapse requiring cardiopulmonary resuscitation (CPR).


METHODS
The study population was composed of death events caused by acute drug poisoning, defined as poisoning deaths and deaths averted (persons successfully resuscitated from out-of-hospital cardiac arrest by EMS) in King County, Washington, during the year 2000.


RESULTS
Eleven persons were successfully resuscitated and 234 persons died from cardiac arrest caused by acute drug poisoning, for a total of 245 cardiac events. The EMS responded to 79.6% (195/245), attempted resuscitation in 34.7% (85/245), and successfully resuscitated 4.5% (11/245) of all events. Among the 85 persons for whom EMS attempted resuscitation, opioids, cocaine, and alcohol were the predominant drugs involved, although over half involved multiple drug classes. Among the 11 persons successfully resuscitated, return of circulation was achieved in six following EMS cardiopulmonary resuscitation alone, in one following CPR and defibrillation, and in the remaining four after additional advanced life support.


CONCLUSIONS
In this community, EMS was involved in the majority of acute drug poisonings characterized by cardiovascular collapse and may potentially lower total mortality by approximately 4.5%. The results show that, in some survivors, return of spontaneous circulation may be achieved with CPR alone, suggesting a different pathophysiology in drug poisoning compared with cardiac arrest due to heart disease.
Paredes
Valentine L
VL
Department of Medicine, University of Washington, Seattle, WA, USA. vparedes@u.washington.edu
Rea
Thomas D
TD
Eisenberg
Mickey S
MS
Cobb
Leonard A
LA
Copass
Michael K
MK
Cagle
Anthony
A
Martin
Thomas G
TG
D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data; D062787:Drug Overdose / Q000150:complications / Q000401:mortality*; D004554:Electric Countershock / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000379:methods* / Q000592:standards; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D019966:Substance-Related Disorders / Q000150:complications; D016019:Survival Analysis; D014861:Washington / Q000453:epidemiology