TOPLINE:
Overdose (OD)-related out-of-hospital cardiac arrest (OHCA) more than doubled from 2015 to 2021, with the greatest increase among those consuming combined stimulants and opioids — a group that also had the lowest survival — new research suggests.
METHODOLOGY:
- Researchers studied 6790 adults with OHCA in King County, Washington, from 2015 to 2021.
- OHCA etiology was classified as non–OD-OHCA or OD-OHCA. Drug-specific profiles were (1) opioid without stimulant; (2) stimulant without opioid; (3) opioid and stimulant; and (4) all other nonstimulant, nonopioid drugs.
- Opioids included fentanyl, heroin, hydromorphone, methadone, opium, codeine, and oxycodone. Stimulants included amphetamines, methamphetamines, and cocaine.
- The primary outcome was survival to hospital discharge.
TAKEAWAY:
- 702 patients (median age, 41 years) developed OD-OHCA and 6088 (median age, 66 years) had non–OD-OHCA.
- The incidence of OD-OHCA more than doubled during the study period, from 5.2 per 100,000 person-years in 2015 to 13.0 per 100,000 person-years in 2021, whereas there was no significant change in the incidence of non–OD-OHCA.
- When stratified by drug profile, combined opioid-stimulant OHCA use had increased almost fourfold during the study period.
- At the end of emergency services care, patients with combined opioid-stimulant OHCA were least likely to be alive compared with patients with other drug-specific OHCA (31% vs 39%) or other OD profiles (31% vs 50%).
- Patients with combined opioid-stimulant OHCA also had the lowest survival to hospital discharge (10%) compared with patients with stimulant-only OHCA (22%) or those with OHCA due to other drugs (26%); the differences persisted after multivariable adjustment.
IN PRACTICE:
OD-OHCA "presentation and outcome differed according to the drug-specific profile," the authors concluded. "The combination of increasing incidence and lower survival among patients with opioid-stimulant OHCA supports prevention and treatment initiatives that consider the drug-specific profile."
SOURCE:
Vidhushei Yogeswaran, MD, University of Washington, Seattle, led the study, which was published online in JAMA Network Open on November 7.
LIMITATIONS:
The observational study is from a single metropolitan emergency medical services system and may not be generalizable to other populations. Race and ethnicity were not ascertained, potentially limiting the generalizability further. Some drug misclassification may have occurred during the toxicology examinations of blood and urine samples.
DISCLOSURES:
The study did not receive external funding. No conflicts of interest were declared.
Comments