title: Recreational drug overdose-related cardiac arrests: break on through to the other side.
abstract: BACKGROUND
  The annual rate of recreational overdose (OD)-related death is increasing exponentially, making unintentional overdose the leading cause of injury-related death in America. Unfortunately, little attention in the resuscitation community has focused on the post-arrest care of this rapidly growing population.
  
  
  METHODS
  We included patients presenting between January 2009 and February 2014 after out-of-hospital cardiac arrest (OHCA) and abstracted baseline clinical characteristics and neurological outcomes. We considered an arrest to be an OD OHCA if toxicology screens were positive and not explained by therapeutic medication administration or home medications; or if there was a history strongly suggestive of OD. We compared the baseline clinical characteristics and outcomes between the OD and non-OD cohorts.
  
  
  RESULTS
  In total, 591 OHCA patients were admitted, of which 85 (14%) arrests were OD-related. OD OHCA patients were significantly younger, had fewer medical comorbidities, were more likely to present with non-shockable rhythms and had worse baseline neurological function. However, overall survival, neurological outcomes and length of stay did not vary between groups. OD OHCA patients who survived to discharge had a significantly higher rate of favorable discharge dispositions (83% of OD OHCA survivors discharged to home or acute rehabilitation vs 62% of non-OD OHCA (P=0.03)).
  
  
  CONCLUSIONS
  Patients who have suffered an OD OHCA make up a significant proportion of the overall OHCA population. Despite poor baseline prognostic factors, survival after OD OHCA was no worse than after non-OD OHCA, and among survivors a majority had a good neurological outcome.
authors: Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, United States; Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, United States; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, United States. Electronic address: elmerjp@upmc.edu.
authors: Jonathan
authors: J
authors: Elmer
authors: Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, United States; Division of Medical Toxicology, University of Pittsburgh, Pittsburgh, PA, United States.
authors: Michael J
authors: MJ
authors: Lynch
authors: Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, United States.
authors: Jeffrey
authors: J
authors: Kristan
authors: Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, United States.
authors: Patrick
authors: P
authors: Morgan
authors: Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, United States.
authors: Stacy J
authors: SJ
authors: Gerstel
authors: Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, United States; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, United States.
authors: Clifton W
authors: CW
authors: Callaway
authors: Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, United States.
authors: Jon C
authors: JC
authors: Rittenberger
mesh_terms: D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation; D016022:Case-Control Studies; D062787:Drug Overdose / Q000150:complications* / Q000401:mortality* / Q000628:therapy; D005260:Female; D006760:Hospitalization; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000139:chemically induced* / Q000401:mortality* / Q000628:therapy; D017063:Outcome Assessment, Health Care; D015996:Survival Rate
chemical_list: D013287:Illicit Drugs
keywords: Cardiac arrest; Neurological outcome; Overdose; Recreational drug; Survival