Evaluating the accuracy of surrogate markers for identifying opioid-associated out-of-hospital cardiac arrests

IF 4.6 1区医学 Q1 CRITICAL CARE MEDICINE Resuscitation Pub Date : 2025-03-05 DOI:10.1016/j.resuscitation.2025.110569

Jamie Jasti, Kristopher Kennedy, M. Riccardo Colella, Tom P. Aufderheide

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Abstract

Background

Previous studies have used emergency medical services (EMS) naloxone administration and EMS overdose impression as surrogate markers to identify opioid-associated (OA) out-of-hospital cardiac arrests (OA-OHCA). We evaluated the accuracy of these two surrogate markers using medical examiner post-mortem toxicology data in OHCA patients who died.

Methods

We conducted a retrospective cohort study of all adult (≥18) non-traumatic OHCA patients treated by Milwaukee County EMS between January 1st, 2015 to December 31st, 2016. EMS naloxone administration and EMS impression of cardiac arrest etiology were used to classify expired patients into 2 groups: (1a) Received ≥1 Naloxone (1b) No Naloxone, and (2a) EMS-impression overdose, (2b) Not EMS-impression overdose. Milwaukee County Medical Examiner (MCME) opioid toxicology data was used as the reference standard and matched to EMS-treated OHCA patients that expired to determine the sensitivity (SN), specificity (SP), positive predictive value (PPV), and the negative predictive value (NPV) of both surrogate markers.

Results

1,654 OHCA cases were included; 112 (6.8%) received ≥1 Naloxone and 1,542 (93.2%) received No Naloxone; 60 (3.6%) were EMS-impression overdose and 1,594 (96.4%) were not EMS-impression overdose. Of the 525 opioid-associated deaths in the MCME Drug-related Death Database, 150 (28.6%) were OA-OHCA cases treated by EMS. The SN, SP, PPV, and NPV for EMS naloxone administration was 39%, 96%, 52%, and 94% respectively. The SN, SP, PPV, and NPV for EMS-impression overdose was 27%, 99%, 68%, and 93% respectively.

Conclusion

EMS naloxone administration and EMS- impression overdose had limited sensitivity for identifying OA-OHCA in expired patients in this large urban EMS system. Prehospital and public health researchers should identify improved methods for accurately classifying this OHCA subpopulation.

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评估阿片类药物相关院外心脏骤停替代标志物的准确性

背景：以前的研究使用紧急医疗服务（EMS）纳洛酮给药和EMS过量印象作为替代标记来识别阿片类药物相关（OA）院外心脏骤停（OA- ohca）。我们使用死亡的OHCA患者的法医尸检毒理学数据评估了这两种替代标记物的准确性。方法：我们对2015年1月1日至2016年12月31日在密尔沃基县EMS治疗的所有成人（≥18岁）非创伤性OHCA患者进行回顾性队列研究。采用EMS纳洛酮给药和EMS对心脏骤停病因的印象将过期患者分为2组：1a)服用纳洛酮≥1次；1b)未服用纳洛酮；2a) EMS印象过量；2b)未使用EMS印象过量。以Milwaukee County Medical Examiner （MCME）阿片类药物毒理学数据作为参考标准，并与ems治疗的过期OHCA患者相匹配，确定两种替代标志物的敏感性（SN）、特异性（SP）、阳性预测值（PPV）和阴性预测值（NPV）。结果：共纳入1654例OHCA病例；服用≥1纳洛酮112例（6.8%），未服用纳洛酮1542例（93.2%）；60例（3.6%）为ems印模过量，1594例（96.4%）为非ems印模过量。在MCME药物相关死亡数据库中的525例阿片类药物相关死亡中，150例（28.6%）是EMS治疗的OA-OHCA病例。EMS纳洛酮给药的SN、SP、PPV和NPV分别为39%、96%、52%和94%。EMS-印象用药过量的SN、SP、PPV和NPV分别为27%、99%、68%和93%。结论：在该大型城市EMS系统中，EMS纳洛酮给药和EMS印模过量对识别过期患者OA- OHCA的敏感性有限。院前和公共卫生研究人员应该确定改进的方法来准确地对OHCA亚群进行分类。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Resuscitation 医学-急救医学

CiteScore

12.00

自引率

18.50%

发文量

556

审稿时长

21 days

期刊介绍： Resuscitation is a monthly international and interdisciplinary medical journal. The papers published deal with the aetiology, pathophysiology and prevention of cardiac arrest, resuscitation training, clinical resuscitation, and experimental resuscitation research, although papers relating to animal studies will be published only if they are of exceptional interest and related directly to clinical cardiopulmonary resuscitation. Papers relating to trauma are published occasionally but the majority of these concern traumatic cardiac arrest.