Written by Andy Hogan
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This analysis of more than 700 out-of-hospital cardiac arrest (OHCA) patients in an area with a high prevalence of opioid overdose did not find an association between naloxone administration and improved patient outcomes.
We Nar-can give naloxone during OHCA, but Nar-should we?
This retrospective observational study of 769 consecutive OHCA patients examined whether administration of naloxone during cardiac arrest resuscitation resulting in improved rates of ROSC, survival to hospital discharge, or neurologically-intact survival. All patients were treated by EMS clinicians from a single, hospital-based ambulance service who were permitted to administer naloxone in any suspected case of opioid overdose. Outcomes were not found to be significantly different between those patients who received naloxone and those who didn’t. Further matched cohort analysis of 159 patients from both the exposure and control group yielded similar, non-significant results.
The elephant in the room is an inescapable selection bias involved with the choice by individual paramedics to administer naloxone based on individualized and unknown criteria, although chart review of the naloxone recipients suggested that “almost all” had a “high likelihood of opiate use.” Furthermore, critical data points including no-flow time, time of naloxone administration, and route of administration were not accounted for in the analysis. Ultimately, there are still too many unknowns to determine the role of naloxone in OHCA from these findings.
How will this change my practice?
In the absence of prior evidence supporting use of naloxone during OHCA, the most recent American Heart Association guidelines recommend prioritizing standard resuscitative interventions over opioid reversal, while also recommending more research into the role of naloxone in opioid-associated arrest. The AHA won’t be changing its recommendation based on these results. Likewise, I won’t be rushing out any urgent updates to my EMS protocols. This study’s lead author even argues elsewhere that observational studies simply can’t be relied on for this sort of practice change. I wonder if another recent study on the same subject would agree?
To be continued… Tomorrow, we will look at another observational study on naloxone and OHCA.
Source
Outcomes of Out-of-Hospital Cardiac Arrest Patients Who Received Naloxone in an Emergency Medical Services System With a High Prevalence Of Opioid Overdose. J Emerg Med. 2024 Sep;67(3):e249-e258. doi: 10.1016/j.jemermed.2024.03.038. Epub 2024 Apr 9. PMID: 39034160.
