Opioid-Specific Advanced Life Support Therapies for Cardiac Arrest
Red Cross Guidelines
- Cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use remain the first interventions for cardiac arrest in opioid-associated overdose and should not be delayed or interrupted.REAFFIRMED
- For suspected opioid-associated cardiac arrest, healthcare professionals should use standard cardiac arrest resuscitation guidelines and consider administration of naloxone without interruption of resuscitation efforts.
- If there is uncertainty whether a person with suspected opioid poisoning is in cardiac arrest, administer naloxone as soon as possible without disrupting or delaying CPR or AED use. UPDATED
- For lay responders caring for a person with suspected cardiac arrest due to opioids, naloxone should be administered as soon as possible without disrupting or delaying CPR and AED use. UPDATED
Insights
Approximately 75% of the annual 105,000 drug overdose deaths in the United States involve opioids. Naloxone is an opioid antagonist available over the counter that is effective in reversing opioid-induced respiratory depression, thus averting cardiac arrest. Once cardiac arrest occurs, it is unclear whether naloxone or other intra-arrest medications, such as sodium bicarbonate, are of any benefit. No studies have assessed outcomes following naloxone administration in patients specifically with opioid-associated cardiac arrest.
Observational studies of patients with undifferentiated out-of-hospital cardiac arrest (OHCA) report that naloxone was not associated with survival to hospital discharge, while another study of OHCA with an initial nonshockable rhythm found naloxone to be associated with improved survival and increased odds of favorable neurological outcomes. Similarly mixed findings have been reported for return of spontaneous circulation.
For intra-arrest use of sodium bicarbonate one large study of OHCA with suspected drug overdose reported that the administration of sodium bicarbonate was associated with a decreased odds of survival to hospital discharge, compared with no administration of sodium bicarbonate.
Although current evidence does not support routine naloxone use by healthcare professionals during resuscitation for opioid-associated cardiac arrest due to the risk of interfering with other evidence-based intervention, the Red Cross guidelines continue to recommend considering naloxone administration, provided it does not disrupt or delay CPR or AED use.