Abstract 236: Regional Incidence and Outcome of Out-of-Hospital Cardiac Arrest Associated with Overdose
Introduction: The frequency of lethal overdose due to prescription and non-prescription drugs is increasing in North America. The contribution of drug overdose (OD) to regional variation in the incidence and outcome out-of-hospital cardiac arrest (OHCA) is unclear.
Objective: To estimate overall and regional variation in incidence and outcomes of emergency medical services (EMS)-treated OD-OHCA cases across North America.
Methods: The Resuscitation Outcomes Consortium (ROC) is a clinical research network with 10 regional clinical centers in United States (US) and Canada that uses uniform methods for surveillance of all EMS-treated OHCA in participating regions. Cases of OHCA from 2006 to 2010 were reviewed for evidence of association with or without OD. Incidence of OD-OHCA was calculated as the number of OD-OHCA in a region per 100,000 cumulative person-years, using 2000 US Census and 2006 Statistics Canada population counts. Patient and EMS characteristics as well as outcome were described. Multiple logistic regression was used to describe the association between OD status on return of spontaneous circulation (ROSC) and survival to hospital discharge, while adjusting for case characteristics and consortium center.
Results: Included were 56,272 cases of OHCA. Regional incidence of OD-OHCA varied between 0.5 and 2.7 per 100,000 person years (p<0.001), and proportion of OD-OHCA among all EMS-treated OHCA ranged from 0.9% to 3.8%. Table 1 shows outcomes and characteristics stratified by OD status; OD-OHCA were younger, less likely to be witnessed, and less likely to present with a shockable rhythm. Compared to non-OD, OD-OHCA was associated with ROSC (OR: 1.55; 95%CI: 1.35-1.78) and survival (OR: 2.14; 95%CI: 1.72-2.65).
Conclusions: OD-OHCA are a small proportion of all OHCA, although incidence varied up to 5-fold across regions. OD-OHCA were more likely to survive than non-OD-OHCA.
Author Disclosures: D.D. Salcido: None. A.C. Koller: None. C.D. Torres: None. A.M. Orkin: None. R.H. Schmicker: None. L.J. Morrison: Research Grant; Modest; NIH, Heart and Stroke Foundation of Canada, Canadian Institute of Health Research. G. Nichol: Research Grant; Modest; NHLBI, Bethesda, MD. Resuscitation Outcomes Consortium Coordinating Center. Co-PI., FDA, Silver Spring, MD; Cardiac Science Corp, Waukesha, WI; Heartsine Technologies Inc., Newtown, PA; Philips Healthcare Inc., Bothell, WA; Physio-Control Inc., Redmond, WA; ZOLL Inc, Chelmsford, MA., PI, Dynamic AED Registry, NHLBI, Bethesda, MD. Randomized Field Trial of Cold Saline IV After Resuscitation from Cardiac Arrest. Co-I., Velomedix Inc., Menlo Park, CA. Velocity Pilot Study of Ultrafast Hypothermia in Patients with ST-Elevation Myocardial Infarction. National Co-PI. *Waived personal compensation., Philips Healthcare Inc., Bothell, WA. Washington Study of Ultrasound in Resuscitation.. Other; Modest; Non-provisional patent for novel method of tracking medical devices using smartphone, and dynamic electronic database (assigned to UW).. S.W. Stephens: None. J.J. Menegazzi: None.
- © 2014 by American Heart Association, Inc.