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Out-of-hospital cardiac arrest caused by acute intoxication

Hidetada Fukushima1, Tomoo Watanabe, Hideki Asai

  • 1Department of Emergency and Critical Care Medicine, Nara Medical University.

Chudoku Kenkyu : Chudoku Kenkyukai Jun Kikanshi = the Japanese Journal of Toxicology
|April 13, 2010
PubMed

Insights

Out-of-hospital cardiac arrest (OHCA) due to acute intoxication is rare. Cardiopulmonary resuscitation (CPR) appears effective for intoxication-related OHCA, particularly from organophosphates or barbiturates.

Area of Science:

  • Toxicology
  • Emergency Medicine
  • Cardiology

Background:

  • Out-of-hospital cardiac arrest (OHCA) presents unique challenges in emergency care.
  • Acute intoxication is an infrequent but significant cause of OHCA.
  • Understanding the specific agents and outcomes is crucial for improving prehospital management.

Purpose of the Study:

  • To analyze the characteristics and outcomes of OHCA cases resulting from acute intoxication.
  • To evaluate the effectiveness of prehospital resuscitation efforts in these specific cases.
  • To identify factors associated with survival in intoxication-induced OHCA.

Main Methods:

  • Retrospective review of 20 OHCA cases due to acute intoxication (April 1999-March 2008).
  • Analysis of causative agents, witness status, prehospital resuscitation, and patient outcomes.
  • Comparison of outcomes based on the type of intoxicating agent.

Main Results:

  • Organophosphates (8 cases), carbon monoxide (5), and barbiturates (3) were the primary agents.
  • Eight cases achieved restoration of spontaneous circulation; four survived with good neurological outcome (Overall Performance Category 1).
  • All survivors were victims of organophosphate or barbiturate intoxication, suggesting these agents may be more amenable to resuscitation.

Conclusions:

  • Acute intoxication is a rare cause of OHCA, with organophosphates and barbiturates associated with better survival rates.
  • Cardiopulmonary resuscitation (CPR) alone may be effective in restoring spontaneous circulation for intoxication-related OHCA.
  • Emphasis on prehospital CPR for intoxication-induced OHCA, similar to cardiogenic OHCA, is warranted.

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