People whose hearts stop suddenly after a drug overdose are younger, have fewer health problems, suffer fewer neurological problems and are more likely to survive than people who experience out-of-hospital cardiac arrest from other causes, according to a new study.
The study, published Wednesday in the Journal of the American Heart Association, found that drug-related cardiac arrests are also less likely to be witnessed and less likely to result in a shockable heart rhythm that can respond to a defibrillator shock.
“Many communities face the ongoing challenge of increasing drug overdoses, which tend to affect younger, healthier populations,” lead study author Aditya C. Shekhar said in a news release. Shekhar is a medical student at the Icahn School of Medicine at Mount Sinai in New York City. “Given the recent increase in drug overdose-related deaths, there is significant public health interest in better understanding these types of cardiac arrests and how to treat them.”
Cardiac arrest occurs when the heart suddenly stops. According to the American Heart Association, approximately 350,000 cardiac arrests occur outside of a hospital each year. Most are caused by heart attacks or electrical problems with the heart, but cardiac arrests related to opioid overdoses are the leading cause of death in adults ages 25 to 64.
Even people who survive cardiac arrest may suffer brain damage, internal organ damage, and other problems.
The researchers used data from the National Cardiac Arrest Registry System (CARES) database to compare out-of-hospital cardiac arrests due to drug overdose with cardiac arrests due to other causes. Of the 360,000 cardiac arrests from 2017 to 2021, 8% were due to drug overdose. Drug-related cardiac arrests included both intentional and accidental overdoses of drugs, legal and illegal drugs, and alcohol.
The majority of people who had drug-related cardiac arrest (about 95%) initially had a non-shockable rhythm, meaning one that did not respond to a defibrillator, compared with 79% of people whose arrest was for other reasons. Nevertheless, they were significantly more likely to survive and had better neurological outcomes.
If the initial rhythm was shockable, survival was similar in both groups.
People who suffered an overdose-related cardiac arrest were twice as likely to return to living independently and perform daily activities without assistance compared to people whose cardiac arrest was caused by other causes.
People who experienced cardiac arrest due to an overdose were younger on average – 39 years old, compared with 64 years old for those who experienced cardiac arrest from other causes – and were less likely to have health conditions, such as type 2 diabetes, high blood pressure, kidney disease, heart disease, respiratory disease, high cholesterol and stroke.
“We were surprised to see that patients with non-shockable rhythms from drug-related cardiac arrest had significantly better survival and neurological outcomes, even when controlling for age and other factors,” lead study author Ryan A. Coote, PhD, assistant professor of emergency medicine at the Gesink College of Medicine at the University of Alabama at Birmingham, said in a statement.
“Our study suggests that different causes of cardiac arrest tend to have different characteristics and, as a result, different outcomes, which may increase the need to treat each cause of cardiac arrest with different techniques,” he said.
The analysis also showed that only one in five drug-related cardiac arrests were witnessed by bystanders, compared with nearly half of arrests due to other causes.
Shekhar noted that receiving bystander CPR can play a key role in a person’s chances of survival.
“When a patient goes into cardiac arrest, the brain is starved of oxygen and within minutes, brain cells begin to die,” he said. “By providing CPR, we can get blood to the brain more quickly and it has been shown to dramatically improve recovery from cardiac arrest.”
