National trends and outcomes of cardiac arrest in opioid overdose

To investigate the epidemiology and outcomes of cardiac arrests associated with opioid overdoses. Recent data suggest that drug overdoses are responsible for more deaths than motor vehicle crashes or firearms in the United States each year, with opioids being involved in majority of drug overdose deaths. Despite the potential for opioids to cause cardiac arrest, few studies have examined this association.

Using data from National (Nationwide) Inpatient Sample database from years 2000-2013, we identified hospitalizations with drug overdoses using ICD-9-CM codes. We further identified those with opioid overdose and those with cardiac arrest. We then assessed the proportion and trends of cardiac arrest and associated mortality in patients with opioid overdose. We also investigated if opioid overdose is an independent risk factor for cardiac arrest and mortality.

Of 3,835,448 United States drug overdose hospitalizations, 16.4% were associated with prescription opioid overdose and 2.3% with heroin overdose. Cardiac arrest was most common with heroin overdose, followed by prescription opioids and least common in non-opioid overdose (3.8% vs 1.4% vs 0.6%; p<0.001). Heroin overdoses have seen the greatest increase in rate of cardiac arrests. Both prescription opioids and heroin overdose were independent risk factors for cardiac arrest and mortality in these patients.

Cardiac arrest is more common in patients with opioid overdoses in comparison to non-opioid overdoses. The rate of cardiac arrest is increasing disproportionately in patients with opioid overdoses. Opioid overdoses are independent risk factors for both cardiac arrest and mortality in patients with overdoses.