Physician and Nonphysician Health-care Provider Perspectives on Resuscitation of Suspected Drug-related Out-of-Hospital Cardiac Arrest

Abstract

Introduction. In the United States, out-of-hospital cardiac arrest from drug overdose (OD-OHCA) caused over 38,000 deaths in 2010. A study in Pittsburgh found that OD-OHCA patients differed demographically and in the resuscitation treatments they received, despite identical AHA resuscitation guidelines. We hypothesized that health-care provider perceptions affect decision-making in the treatment of OD-OHCA versus non-OD OHCA. Methods. We conducted this survey at the National Association of EMS Physicians 2013 Scientific Assembly. Physicians and non-physician health-care providers were given one of two surveys containing 19 questions pertaining to the respondents’ affiliated EMS agencies, the estimated proportion of OD-OHCA as well as the drugs involved, and the respondents’ belief about the treatments for OD versus non-OD OHCA. Results. One hundred ninety-three respondents participated in this survey. Of the 193, 144 (75%) were physicians and 49 (25%) were nonphysicians. Seventy-nine percent of physicians identified current status as a medical director and 76% of nonphysicians identified as a paramedic. Participants estimated the average monthly proportion of all OHCA due to OD to be 9.4%. Participants ranked opioids, alcohol, antidepressants, and benzodiazepines as the most commonly utilized agents in OD-OHCA. The majority of physicians (42%) felt that the incidence of OD-OHCA was not changing while the majority of nonphysicians (53%) felt the incidence was increasing. Eighty-four percent of all respondents reported the use of naloxone during OD-OHCA resuscitation, while 13% reported administering naloxone during non-OD OHCA resuscitation. Eighty-nine percent of physicians and 67% of nonphysicians indicated that OD-OHCA patients had different demographics than non-OD OHCA, with primary reported differences being age, comorbidities, and socioeconomic status. Sixty-three percent of physicians and 71% of nonphysicians felt that OD-OHCA patients should be treated differently, with primary differences being the incorporation of etiology-specific treatments, performing different CPR with a focus on airway support, and transporting earlier. Conclusions. When surveyed, physicians and nonphysician providers report perceiving OD-OHCA treatment, outcomes, and patient demographics differently than non-OD OHCA and making different treatment decisions based on these perceptions. This may result in etiology-oriented resuscitation in the out-of-hospital setting, despite the lack of OD-specific resuscitation guidelines.

Key words: :

• cardiac arrest
• resuscitation
• drug overdose
• EMS system