Resuscitation 94 (2015) 23–27 Contents lists available at ScienceDirect Resuscitation jou rn al hom ep age : w ww.elsevier.com/locate/resuscitation Clinical Paper Outcomes of patients resuscitated from cardiac arrest in the setting of drug overdose Alexander Z. Katz ∗ , Anne V. Grossestreuer, David F. Gaieski, Benjamin S. Abella, Vinayak Kumar, Jeanmarie Perrone Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States a r t i c l e i n f o Article history: Received 4 February 2015 Received in revised form 8 June 2015 Accepted 12 June 2015 Keywords: Cardiac arrest Drug overdose Overdose Targeted temperature management Prescription drugs a b s t r a c t Objectives: To compare the attributes and clinical outcomes of patients with cardiac arrest in the setting of drug overdose (OD) to patients with cardiac arrest from non-drug related etiologies. Methods: We utilized a US inpatient cardiac arrest registry used to study targeted temperature manage- ment (TTM) to identify patients with cardiac arrest in the setting of drug overdose between 2005 and 2013. Data regarding the cardiac arrest, resuscitation interventions, use of post-arrest TTM, urine drug screen, survival, and neurologic outcome were examined. These results were compared to patients suf- fering cardiac arrest from other causes during the same time period using Wilcoxon rank-sum tests for continuous variables and chi-square tests on categorical variables. Results: Approximately 2.5% (64/2584) of cardiac arrests occurred in the setting of drug overdose. Patients in the OD cohort were younger, more likely to be male, and more likely to have an out-of-hospital cardiac arrest that was unwitnessed with no bystander CPR and from a non-shockable rhythm. However, the patients in the OD cohort had similar rates of survival and good neurologic outcomes (Cerebral Perfor- mance Category 1–2) compared to non-OD patients. A fraction of initially resuscitated patients in each group (8% in OD cohort vs. 15% in non-OD cohort, p = ns) did not receive post-arrest TTM due to prompt awakening following resuscitation. Conclusions: Patients resuscitated from cardiac arrest in the setting of drug OD have neurologic and sur- vival outcomes comparable to non-OD patients despite lower rates of bystander CPR, shockable rhythms, and witnessed arrest. © 2015 Elsevier Ireland Ltd. All rights reserved. 1. Introduction There are approximately 424,000 EMS-assessed out of hospital cardiac arrests each year in the United States, with approximately 60% of these treated by EMS personnel. 1 During cardiopulmonary resuscitation (CPR) one of the core tasks is to identify and treat reversible causes of arrest including drug overdose. Adverse car- diovascular events have been reported to occur in up to 9.3% of all drug overdoses and in up to 16.9% of hospital admissions for drug overdose. 2 Recently, prescription drug overdose (OD) has become the leading cause of accidental death in the United States. 3 In 2011, approximately 110 Americans died from drug OD each day, and prescription opioid analgesics accounted for over 16,900 (42%) of these deaths, representing more than a three-fold increase since ∗ Corresponding author at: University of Pennsylvania, Department of Emergency Medicine, Ground Ravdin, 3400 Spruce, Philadelphia, PA 19104, United States. E-mail address: Alexander.katz@uphs.upenn.edu (A.Z. Katz). 1999. 4 Heroin was responsible for an additional 4300 deaths in 2011 as well. 5 In addition to the morbidity and mortality associated with prescription drug OD, they also constitute an enormous pub- lic health and financial burden on the healthcare system. Almost 500,000 emergency department visits in 2009 were due to the mis- use or abuse of prescription opioid analgesics. 4 Other illicit drugs including cocaine, heroin, amphetamines, and marijuana also con- tinue to be commonly abused, and in 2012, 9.2% of all Americans over the age of 11 used an illicit drug in the prior month compared to 8.3% in 2002. 6 This is a concerning trend that may further increase the incidence of lethal drug overdose. Although fatal drug OD have increased in the past decade, little is known about the outcomes of patients resuscitated from cardiac arrest in the setting of drug OD and how these outcomes compare to the outcomes of patients resuscitated from cardiac arrest secondary to other etiologies. There is a continuum of outcomes after cardiac arrest, beginning with return of spontaneous circulation (ROSC), followed by admission to the hospital, and subsequently including survival to hospital discharge and neurologic outcome at discharge. http://dx.doi.org/10.1016/j.resuscitation.2015.06.015 0300-9572/© 2015 Elsevier Ireland Ltd. All rights reserved.