By Sarah Roebuck
EMS1
SAN FRANCISCO — When opioid overdose patients with a pulse are treated, first responders commonly administer naloxone as a life-saving intervention. However, naloxone use in opioid-associated out-of-hospital cardiac arrest (OHCA) cases where patients lack a pulse is far less standardized, with EMS protocols differing significantly, according to UC Davis Health.
Recognizing this gap in evidence, researchers at UC Davis Health conducted a study to evaluate the impact of paramedics’ naloxone administration on OHCA patients.
The study, published in JAMA Network Open, found a significant association between the use of naloxone and both the return of spontaneous circulation and survival to hospital discharge. These findings suggest that naloxone may play a crucial role even in severe cases of opioid overdose where cardiac arrest occurs.
“The incidence of drug-related cardiac arrests has skyrocketed in the past two decades, and there is an urgent need for evidence to guide possible naloxone use in this circumstance,” said David Dillon, assistant professor of Emergency Medicine and one of the study’s authors.
Recent studies estimate that 17.6% of all out-of-hospital cardiac arrests and 34% of OHCA cases in individuals under 60 are due to opioid toxicity, according to UC Davis Health.
Here’s an overview of what naloxone is and how responders are helping curb the opioid epidemic:
In a retrospective study, researchers analyzed data from EMS agencies in San Francisco, Sacramento and Yolo counties spanning from 2015 to 2023. The study included a total of 8,195 patients who experienced OHCA and received treatment from these agencies.
The findings revealed that naloxone administration by EMS was significantly associated with better patient outcomes. Specifically, the “number needed to treat” (NNT) – the number of patients who need to receive naloxone to observe one additional positive outcome – was nine for the return of spontaneous circulation and 26 for survival to hospital discharge.
“Surprisingly, our findings showed that naloxone was associated with improved clinical outcomes in both drug-related cardiac arrests and non-drug related cardiac arrests,” said Dillon. “This is important because it adds to our understanding about the effectiveness of naloxone for drug related out-of-hospital cardiac arrest.”
The researchers emphasized that these findings warrant further investigation, especially considering the escalating opioid crisis in the United States and the potential role of naloxone in cardiac arrest management.
