Nov 18 2024 3 mins
Contributor: Aaron Lessen MD
Educational Pearls:
Can opioids cause cardiac arrest?
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Opioids can cause respiratory suppression and the subsequent low oxygen levels can lead to arrhythmias and eventually cardiac arrest.
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In 2023, 17% of out-of-hospital cardiac arrests (OHCA) were attributable to opioids.
Given that this is a rising cause of cardiac arrest, should we just treat all cardiac arrest with naloxone (Narcan)?
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Naloxone is correlated with an increased chance of return of spontaneous circulation (ROSC)
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Additionally, a wide variety of individuals can be exposed to opioids and therefore opioid overdose should be considered in all cases of OHCA
But does naloxone improve neurologic outcomes?
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Yes, naloxone, especially when given early on in the resuscitation can improve neuro outcomes
What is the dose?
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2-4 mg IN/IV depending on access.
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High suspicion for opioid overdose consider going with an even higher dose such as 4-8 mg IN/IV
References
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Orkin, A. M., & Dezfulian, C. (2024). Recognizing the fastest growing cause of out-of-hospital cardiac arrest. Resuscitation, 198, 110206. https://doi.org/10.1016/j.resuscitation.2024.110206
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Quinn, E., & Du Pont, D. (2024). Naloxone administration in out-of-hospital cardiac arrest: What's next?. Resuscitation, 201, 110307. https://doi.org/10.1016/j.resuscitation.2024.110307
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Saybolt, M. D., Alter, S. M., Dos Santos, F., Calello, D. P., Rynn, K. O., Nelson, D. A., & Merlin, M. A. (2010). Naloxone in cardiac arrest with suspected opioid overdoses. Resuscitation, 81(1), 42–46. https://doi.org/10.1016/j.resuscitation.2009.09.016
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Wampler D. A. (2024). Naloxone in Out-of-Hospital Cardiac Arrest-More Than Just Opioid Reversal. JAMA network open, 7(8), e2429131. https://doi.org/10.1001/jamanetworkopen.2024.29131
Summarized by Jeffrey Olson, MS3 | Edited by Meg Joyce MS1 & Jorge Chalit, OMS3