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01-05-15 What is the outcome of overdose patients following out of hospital cardiac arrest?

Question of the Week

January 5, 2015

What is the outcome of overdose patients following out of hospital cardiac arrest?

Recently the American College of Medical Toxicology presented a Grand Rounds on Cardiac arrest with an emphasis on the overdose patient.  The following are comments that were made in the Grand Rounds:

There are approximately 300,000 out of hospital cardiac arrests  (OHCA) in North America each year.  Although the majority of OHCA are due to acute coronary syndrome, approximately 15% of OHCA have a toxicology component. Fifty percent make it to the hospital.  Outcomes vary significantly based on hospital facility.

Younger people are much less likely to have medical comorbidities.  The most frequent drugs involved are opiates and benzodiazepines.  Forty percent of patients with OHCA caused by overdoses survive.  Eighty percent of those who survive are discharged home or to acute rehab.  Recovery continues beyond rehab.  In animal models, neuro recovery continues for up to 12 months.  Research is looking at drugs that antagonize the NMDA receptor (such as ketamine) as it appears to prevent mitochondrial apoptosis.

Hypothermia improves neurologic outcome following OHCA.  There are special issues with overdose patients, as certain drugs may cause bradycardia, which is also an effect of hypothermia. Recommendations are not to withhold hypothermia but consider “not cooling so cool” i.e. 35°C rather than 32-34°C.  Vasopressors may mitigate bradycardia.  The hypothermia may decrease metabolism of medications as well as the drugs on which the patient overdosed.  Don’t give up too early.

This Question prepared by:  Donna Seger, MD  Medical Toxicologist