Outcome after heroin overdose and cardiopulmonary resuscitation.
BACKGROUND
The survival of heroin overdose patients resuscitated from cardiac arrest is reported to be poor. The aim of our study was to investigate the outcome and characteristics of survivors after cardiac arrest caused by heroin overdose.


METHODS
This was a retrospective study in a medium-sized city (population, 560,000). Between 1 January 1997 and 31 December 2000, there were 94 combined cardiac arrests caused by acute drug poisonings. The main outcome measure was survival to discharge.


RESULTS
Cardiopulmonary resuscitation was attempted in 19 heroin overdose patients (group A) and in 53 patients with cardiac arrest caused by other poisonings (group B). Three (16%) vs. six (11%) patients were discharged alive (group A vs. B, respectively). The survivors in group A had an Emergency Medical Service (EMS)-witnessed cardiac arrest or the Emergency Dispatching Centre was called before the arrest occurred. There was no statistically significant difference between the two groups in terms of survival. Survivors in both groups suffered from acute renal failure (two), hypoglycaemia (four) and hypothermia (three).


CONCLUSIONS
Survival after cardiac arrest caused by heroin overdose is possible if the arrest is EMS witnessed or the Emergency Dispatching Centre is called before the cardiac arrest occurs. In comparison with cardiac arrests caused by other poisonings, there was no difference in survival. The incidence and mechanism of hypoglycaemia should be examined in further studies.
Boyd
J J
JJ
Helsinki Emergency Medical Service, Helsinki University Central Hospital, Helsinki, Finland. james.boyd@hus.fi
Kuisma
M J
MJ
Alaspää
A O
AO
Vuori
E
E
Repo
J V
JV
Randell
T T
TT
D000328:Adult; D002302:Cardiac Output / Q000502:physiology; D016887:Cardiopulmonary Resuscitation; D062787:Drug Overdose; D004632:Emergency Medical Services; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D005387:Finland / Q000453:epidemiology; D006323:Heart Arrest / Q000139:chemically induced / Q000628:therapy; D003932:Heroin / Q000506:poisoning*; D006556:Heroin Dependence / Q000453:epidemiology; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000506:poisoning*; D012206:Rhabdomyolysis / Q000139:chemically induced; D013534:Survival; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D009294:Narcotics; D014662:Vasoconstrictor Agents; D003932:Heroin; D004837:Epinephrine