Opioid-associated cardiac arrest: A systematic review of intra-arrest naloxone and other opioid-specific advanced life-support therapies
Aim: Cardiac arrest due to opioid toxicity is a leading cause of life-years lost in many countries. Since the pathophysiology of cardiac arrest from opioid toxicity is different than primary cardiac etiologies, we sought to identify opioid-specific resuscitative interventions demonstrating benefit....
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Elsevier
2025-03-01
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| Series: | Resuscitation Plus |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666520425000438 |
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| author | Brian Grunau Brian J. O’Neil Dean Giustini Ian R. Drennan Eric J. Lavonas |
| author_facet | Brian Grunau Brian J. O’Neil Dean Giustini Ian R. Drennan Eric J. Lavonas |
| author_sort | Brian Grunau |
| collection | DOAJ |
| description | Aim: Cardiac arrest due to opioid toxicity is a leading cause of life-years lost in many countries. Since the pathophysiology of cardiac arrest from opioid toxicity is different than primary cardiac etiologies, we sought to identify opioid-specific resuscitative interventions demonstrating benefit. Methods: We searched Medline, EMBASE, CENTRAL, and the Web of Science (September 2024) for randomized or observational studies examining the benefit of opioid-specific advanced life support-level therapies for cardiac arrest. The primary and secondary outcomes were favourable neurological outcomes and survival at 30-days or hospital discharge, respectively. Risk of Bias and Certainty of Evidence were assessed with the ROBINS-I tool and GRADE methodology, respectively. Results: We reviewed 1051 studies; six observational studies met criteria for analysis. Five studies examined the association of naloxone and outcomes (three included undifferentiated cases, one included non-shockable initial rhythm cases, and two included cases with “drug overdose”): two reported that naloxone was associated with improved outcomes, and three did not detect an association. One additional study examined the association of bicarbonate and outcomes, reporting that bicarbonate was associated with decreased survival at hospital discharge. All studies were limited by serious risk of bias and indirectness, with the certainty of evidence judged to be very low. No studies exclusively examined opioid-related cases. Conclusions: There is currently no evidence demonstrating benefit for any advanced life support interventions specific to treating cardiac arrest from opioid toxicity. Data examining naloxone for undifferentiated or “drug-related” cardiac arrest are heterogenous with high risk of bias and low certainty of evidence. |
| format | Article |
| id | doaj-art-0226c528c8cb47559ca0e68cd0a991af |
| institution | OA Journals |
| issn | 2666-5204 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Resuscitation Plus |
| spelling | doaj-art-0226c528c8cb47559ca0e68cd0a991af2025-08-20T01:57:48ZengElsevierResuscitation Plus2666-52042025-03-012210090610.1016/j.resplu.2025.100906Opioid-associated cardiac arrest: A systematic review of intra-arrest naloxone and other opioid-specific advanced life-support therapiesBrian Grunau0Brian J. O’Neil1Dean Giustini2Ian R. Drennan3Eric J. Lavonas4Departments of Emergency Medicine, St. Paul’s Hospital and the University of British Columbia, Vancouver, British Columbia, Canada; British Columbia Emergency Health Services, British Columbia, Canada; Corresponding author at: 1190 Hornby St., 4th Floor, Vancouver, BC V6Z 2K5, Canada.Department of Emergency Medicine, Wayne State University, Detroit, MI, United StatesThe University of British Columbia Library, Vancouver, British Columbia, CanadaDivision of Emergency Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Ornge Critical Care Transport, Ontario, Canada; Department of Emergency Services and Sunnybrook Research Institute, Sunnybrook Health Science Centre, Toronto, Ontario, Canada; Division of Emergency Medicine, University of Toronto, Toronto, Ontario, CanadaDepartment of Emergency Medicine and Rocky Mountain Poison and Drug Safety, Denver, CO, United States; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, United StatesAim: Cardiac arrest due to opioid toxicity is a leading cause of life-years lost in many countries. Since the pathophysiology of cardiac arrest from opioid toxicity is different than primary cardiac etiologies, we sought to identify opioid-specific resuscitative interventions demonstrating benefit. Methods: We searched Medline, EMBASE, CENTRAL, and the Web of Science (September 2024) for randomized or observational studies examining the benefit of opioid-specific advanced life support-level therapies for cardiac arrest. The primary and secondary outcomes were favourable neurological outcomes and survival at 30-days or hospital discharge, respectively. Risk of Bias and Certainty of Evidence were assessed with the ROBINS-I tool and GRADE methodology, respectively. Results: We reviewed 1051 studies; six observational studies met criteria for analysis. Five studies examined the association of naloxone and outcomes (three included undifferentiated cases, one included non-shockable initial rhythm cases, and two included cases with “drug overdose”): two reported that naloxone was associated with improved outcomes, and three did not detect an association. One additional study examined the association of bicarbonate and outcomes, reporting that bicarbonate was associated with decreased survival at hospital discharge. All studies were limited by serious risk of bias and indirectness, with the certainty of evidence judged to be very low. No studies exclusively examined opioid-related cases. Conclusions: There is currently no evidence demonstrating benefit for any advanced life support interventions specific to treating cardiac arrest from opioid toxicity. Data examining naloxone for undifferentiated or “drug-related” cardiac arrest are heterogenous with high risk of bias and low certainty of evidence.http://www.sciencedirect.com/science/article/pii/S2666520425000438Opioid toxicityCardiac arrestHeart arrestAdvanced life support |
| spellingShingle | Brian Grunau Brian J. O’Neil Dean Giustini Ian R. Drennan Eric J. Lavonas Opioid-associated cardiac arrest: A systematic review of intra-arrest naloxone and other opioid-specific advanced life-support therapies Resuscitation Plus Opioid toxicity Cardiac arrest Heart arrest Advanced life support |
| title | Opioid-associated cardiac arrest: A systematic review of intra-arrest naloxone and other opioid-specific advanced life-support therapies |
| title_full | Opioid-associated cardiac arrest: A systematic review of intra-arrest naloxone and other opioid-specific advanced life-support therapies |
| title_fullStr | Opioid-associated cardiac arrest: A systematic review of intra-arrest naloxone and other opioid-specific advanced life-support therapies |
| title_full_unstemmed | Opioid-associated cardiac arrest: A systematic review of intra-arrest naloxone and other opioid-specific advanced life-support therapies |
| title_short | Opioid-associated cardiac arrest: A systematic review of intra-arrest naloxone and other opioid-specific advanced life-support therapies |
| title_sort | opioid associated cardiac arrest a systematic review of intra arrest naloxone and other opioid specific advanced life support therapies |
| topic | Opioid toxicity Cardiac arrest Heart arrest Advanced life support |
| url | http://www.sciencedirect.com/science/article/pii/S2666520425000438 |
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