Long-term trends in the epidemiology of out-of-hospital cardiac arrest precipitated by suspected drug overdose

Abstract

Background: Little is known about the long-term trends in the incidence and outcomes of drug overdose out-of-hospital cardiac arrests (OHCA). Method: Between 2000 and 2017, we retrospectively reviewed drug overdose OHCAs from the Victorian Ambulance Cardiac Arrest Registry. Incidence was assessed using linear regression, and the baseline characteristics and survival outcomes were assessed using nonparametric test for trend. Arrest factors associated with survival to hospital discharge were assessed using logistic regression. The 12-month functional recovery and health related quality of life for survivors was summarised using descriptive statistics. Results: The incidence of emergency medical services (EMS)-attended and EMS-treated cases was 5.8 and 2.0 per 100,000 person-years, respectively, with no significant changes in trend over time. Return of spontaneous circulation increased from 23% to 34% (p for trend = 0.001), event survival increased from 23% to 30% (p for trend = 0.007), and survival to hospital discharge increased from 4% to 13% (p for trend = 0.03). Age, arrest witnessed by bystander or EMS, initial shockable rhythm or pulseless electrical activity, intubation, epinephrine and sodium bicarbonate administration were independently associated with survival. The adjusted-temporal trend for survival was not significant (per year increase; OR 1.02, 95% CI: 0.98, 1.07; p = 0.244). Of the 12-month survivors, 50% of the responders reported good functional recovery, and few reported severe problems with mobility, self-care, daily activity, pain, and anxiety/depression. Conclusion: Although the incidence of drug overdose OHCA remained unchanged between 2000 and 2017, the rates of survival have significantly improved.