The incidence and outcomes of out-of-hospital cardiac arrest precipitated by drug overdose

A systematic review and meta-analysis

Saeed Ali S Alqahtani, Ziad Nehme, Brett Williams, Karen L Smith

Research output: Contribution to journalReview ArticleResearchpeer-review

Abstract

Background: Out-of-hospital cardiac arrests (OHCA) precipitated by drug overdose (OD) are becoming an increasing public health problem in developed countries. Empirical data on the global incidence and outcomes are needed to guide preventive and treatment strategies. Methods: We conducted a systematic review using MEDLINE, Embase, Emcare, All EBM Reviews and CINAHL to identify observational or interventional studies reporting the incidence or outcomes of adult OHCA precipitated by drug OD between 1990 and 2018. Pooled incidence rates per 100,000 person-years and survival outcomes were summarised using random-effects models. Results: Twelve articles met the eligibility criteria, of which six were from North America, four from Europe and two from Asia. Only two studies reported the incidence of EMS-attended cases. The pooled incidence of EMS-treated OHCA was 1.4 cases per 100,000 person-years. The pooled rate of survival to hospital discharge and survival with favourable neurological outcome was 9% (95% CI: 6%, 12%; I2 = 90%; p < 0.001) and 6% (95% CI: 2%, 13%; I2 = 81%; p < 0.001), respectively. The pooled rate of return of spontaneous circulation was 25% (95% CI: 11%, 41%; I2 = 97%; p < 0.001). Drug OD OHCA was associated with an improvement in the odds of survival to hospital discharge (pooled odds ratio 2.2, 95% CI: 1.7, 2.7; I2 = 0%; p = 0.45). Conclusion: The incidence and survival outcomes of drug OD OHCA varies substantially across regions. Effective strategies designed to reduce incidence and improve survival outcomes are needed.

Original languageEnglish
Pages (from-to)10-18
Number of pages9
JournalResuscitation
Volume134
DOIs
Publication statusPublished - 1 Jan 2019

Keywords

  • Cardiopulmonary resuscitation
  • Drug overdose
  • Emergency medical services
  • Out-of-hospital cardiac arrest

Cite this

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title = "The incidence and outcomes of out-of-hospital cardiac arrest precipitated by drug overdose: A systematic review and meta-analysis",
abstract = "Background: Out-of-hospital cardiac arrests (OHCA) precipitated by drug overdose (OD) are becoming an increasing public health problem in developed countries. Empirical data on the global incidence and outcomes are needed to guide preventive and treatment strategies. Methods: We conducted a systematic review using MEDLINE, Embase, Emcare, All EBM Reviews and CINAHL to identify observational or interventional studies reporting the incidence or outcomes of adult OHCA precipitated by drug OD between 1990 and 2018. Pooled incidence rates per 100,000 person-years and survival outcomes were summarised using random-effects models. Results: Twelve articles met the eligibility criteria, of which six were from North America, four from Europe and two from Asia. Only two studies reported the incidence of EMS-attended cases. The pooled incidence of EMS-treated OHCA was 1.4 cases per 100,000 person-years. The pooled rate of survival to hospital discharge and survival with favourable neurological outcome was 9{\%} (95{\%} CI: 6{\%}, 12{\%}; I2 = 90{\%}; p < 0.001) and 6{\%} (95{\%} CI: 2{\%}, 13{\%}; I2 = 81{\%}; p < 0.001), respectively. The pooled rate of return of spontaneous circulation was 25{\%} (95{\%} CI: 11{\%}, 41{\%}; I2 = 97{\%}; p < 0.001). Drug OD OHCA was associated with an improvement in the odds of survival to hospital discharge (pooled odds ratio 2.2, 95{\%} CI: 1.7, 2.7; I2 = 0{\%}; p = 0.45). Conclusion: The incidence and survival outcomes of drug OD OHCA varies substantially across regions. Effective strategies designed to reduce incidence and improve survival outcomes are needed.",
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The incidence and outcomes of out-of-hospital cardiac arrest precipitated by drug overdose : A systematic review and meta-analysis. / Alqahtani, Saeed Ali S; Nehme, Ziad; Williams, Brett; Smith, Karen L.

In: Resuscitation, Vol. 134, 01.01.2019, p. 10-18.

Research output: Contribution to journalReview ArticleResearchpeer-review

TY - JOUR

T1 - The incidence and outcomes of out-of-hospital cardiac arrest precipitated by drug overdose

T2 - A systematic review and meta-analysis

AU - Alqahtani, Saeed Ali S

AU - Nehme, Ziad

AU - Williams, Brett

AU - Smith, Karen L

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Out-of-hospital cardiac arrests (OHCA) precipitated by drug overdose (OD) are becoming an increasing public health problem in developed countries. Empirical data on the global incidence and outcomes are needed to guide preventive and treatment strategies. Methods: We conducted a systematic review using MEDLINE, Embase, Emcare, All EBM Reviews and CINAHL to identify observational or interventional studies reporting the incidence or outcomes of adult OHCA precipitated by drug OD between 1990 and 2018. Pooled incidence rates per 100,000 person-years and survival outcomes were summarised using random-effects models. Results: Twelve articles met the eligibility criteria, of which six were from North America, four from Europe and two from Asia. Only two studies reported the incidence of EMS-attended cases. The pooled incidence of EMS-treated OHCA was 1.4 cases per 100,000 person-years. The pooled rate of survival to hospital discharge and survival with favourable neurological outcome was 9% (95% CI: 6%, 12%; I2 = 90%; p < 0.001) and 6% (95% CI: 2%, 13%; I2 = 81%; p < 0.001), respectively. The pooled rate of return of spontaneous circulation was 25% (95% CI: 11%, 41%; I2 = 97%; p < 0.001). Drug OD OHCA was associated with an improvement in the odds of survival to hospital discharge (pooled odds ratio 2.2, 95% CI: 1.7, 2.7; I2 = 0%; p = 0.45). Conclusion: The incidence and survival outcomes of drug OD OHCA varies substantially across regions. Effective strategies designed to reduce incidence and improve survival outcomes are needed.

AB - Background: Out-of-hospital cardiac arrests (OHCA) precipitated by drug overdose (OD) are becoming an increasing public health problem in developed countries. Empirical data on the global incidence and outcomes are needed to guide preventive and treatment strategies. Methods: We conducted a systematic review using MEDLINE, Embase, Emcare, All EBM Reviews and CINAHL to identify observational or interventional studies reporting the incidence or outcomes of adult OHCA precipitated by drug OD between 1990 and 2018. Pooled incidence rates per 100,000 person-years and survival outcomes were summarised using random-effects models. Results: Twelve articles met the eligibility criteria, of which six were from North America, four from Europe and two from Asia. Only two studies reported the incidence of EMS-attended cases. The pooled incidence of EMS-treated OHCA was 1.4 cases per 100,000 person-years. The pooled rate of survival to hospital discharge and survival with favourable neurological outcome was 9% (95% CI: 6%, 12%; I2 = 90%; p < 0.001) and 6% (95% CI: 2%, 13%; I2 = 81%; p < 0.001), respectively. The pooled rate of return of spontaneous circulation was 25% (95% CI: 11%, 41%; I2 = 97%; p < 0.001). Drug OD OHCA was associated with an improvement in the odds of survival to hospital discharge (pooled odds ratio 2.2, 95% CI: 1.7, 2.7; I2 = 0%; p = 0.45). Conclusion: The incidence and survival outcomes of drug OD OHCA varies substantially across regions. Effective strategies designed to reduce incidence and improve survival outcomes are needed.

KW - Cardiopulmonary resuscitation

KW - Drug overdose

KW - Emergency medical services

KW - Out-of-hospital cardiac arrest

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U2 - 10.1016/j.resuscitation.2018.12.020

DO - 10.1016/j.resuscitation.2018.12.020

M3 - Review Article

VL - 134

SP - 10

EP - 18

JO - Resuscitation

JF - Resuscitation

SN - 0300-9572

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