title: Cardiac arrest in patients who smoke crack cocaine.
abstract: The aim of the study is to determine the clinical features and outcomes of cocaine users admitted to the hospital after cardiac arrest and compare them with nonusers. Cocaine is associated with cardiovascular complications, including ventricular arrhythmias; however, resuscitated cardiac arrest in relation to cocaine use is not a well-defined clinical entity. We reviewed available hospital charts at San Francisco General Hospital with the International Classification of Diseases, Ninth Revision diagnosis of cardiac arrest and cocaine use from 1994 to 2006. Clinical features and outcomes of cocaine users were compared with those of randomly selected control patients and age-matched controls with resuscitated cardiac arrest without cocaine use. We identified 22 patients with resuscitated cardiac arrest in the setting of cocaine use. Their average age was 42 +/- 10 years, >20 years younger than nonusers (68 +/- 16 years, p <0.01). After cardiac arrest, 12 of 22 patients (55%) who used cocaine had complete neurologic recovery in contrast to only 3 of 20 unmatched controls (15%, p <0.01) and 7 of 41 age-matched controls (17%, p <0.01). Only 10 of 22 cocaine users (46%) died compared with 15 of 20 unmatched controls (75%, p = 0.05) and 32 of 41 age-matched controls (78%, p <0.01). In a combined analysis of all patients, cocaine use was the only significant predictor of neurologic recovery (p <0.01) and survival (p <0.01). In conclusion, cocaine use is associated with cardiac arrest. In patients with cardiac arrest, cocaine users are younger than nonusers and more likely to survive with neurologic recovery, even compared with age-matched controls with cardiac arrest.
authors.affiliation: Division of Cardiology, San Francisco General Hospital, San Francisco, California, USA.
authors.forename: Priscilla Y
authors.initials: PY
authors.lastname: Hsue
authors.forename: David
authors.initials: D
authors.lastname: McManus
authors.forename: Van
authors.initials: V
authors.lastname: Selby
authors.forename: Xiushui
authors.initials: X
authors.lastname: Ren
authors.forename: Priya
authors.initials: P
authors.lastname: Pillutla
authors.forename: Naji
authors.initials: N
authors.lastname: Younes
authors.forename: Nora
authors.initials: N
authors.lastname: Goldschlager
authors.forename: David D
authors.initials: DD
authors.lastname: Waters
mesh_terms: D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation; D016022:Case-Control Studies; D016578:Crack Cocaine / Q000009:adverse effects*; D004636:Emergency Service, Hospital; D005260:Female; D006323:Heart Arrest / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects*; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D012189:Retrospective Studies; D012495:San Francisco / Q000453:epidemiology; D016019:Survival Analysis
chemical_list: D016578:Crack Cocaine; D013287:Illicit Drugs