Impact of Targeted Temperature Management on ED Patients with Drug Overdose–Related Cardiac Arrest
Drug overdose is the leading cause of non-traumatic out-of-hospital cardiac arrest (OHCA) among young adults. This study investigates whether targeted temperature management (TTM) improves hospital survival from presumed overdose-related cardiac arrest.
Retrospective chart review of consecutive cardiac arrests presenting to an urban tertiary care hospital ED from 2011 to 2015. ED patients with cardiac arrest were included if < 50 years old, and excluded if there was a non-overdose etiology (e.g., trauma, ST-elevation myocardial infarction, subarachnoid hemorrhage). The main intervention was TTM, carried out with a combination of the Arctic Sun device and refrigerated crystalloid/antipyretics (goal temperature 33–36 °C). The primary outcome was survival to hospital discharge; neurologically intact survival was the secondary outcome.
Of 923 patients with cardiac arrest, 802 (86.9%) met exclusion criteria, leaving 121 patients for final analysis. There were 29 patients in the TTM group (24.0%) vs 92 patients in the non-TTM group (76.0%). Eleven patients (9.1%) survived to hospital discharge. TTM was associated with increased odds of survival to hospital discharge (OR 11.3, 95% CI 2.8–46.3, p < 0.001), which increased substantially when palliative outcomes were excluded from the cohort (OR 117.3, 95% CI 17.0–808.4, p < 0.001). Despite achieving statistical significance (OR 1.1, 95% CI 1.0–1.3), TTM had no clinically significant effect on neurologically intact survival.
TTM was associated with improved survival in ED patients with presumed drug overdose–related cardiac arrest. The impact of TTM on neurologically intact survival among these patients requires further study.
KeywordsToxicology Cardiac arrest Targeted temperature management
We thank Yanoh Jalloh, M.P.H., for her contributions to the institutional approvals process.
AFM, CMM, and SB conceived the research questions and study design. AFM supervised the conduct of the study and the data collection. SK reviewed charts and performed data abstraction. AFM provided statistical advice on study design and performed statistical analyses on the data. SK drafted the manuscript, and all authors contributed significantly to its revision. AFM takes responsibility for the paper as a whole.
This study received no explicit funding. Dr. Manini receives salary support from grant DA037317 from the NIH. The other authors do not receive any specific grant funding. The manufacturers of the Arctic Sun device had no role in, or knowledge of, the study protocol.
Compliance with Ethical Standards
Conflict of Interest
- 6.Hedegaard H, Warner M, Minino AM. Drug overdose deaths in the United States, 1999-2015. NCHS Data Brief. 2017:1–8.Google Scholar
- 8.Centers for Disease Control and Prevention Opioid overdose - understanding the epidemic. Opioid overdose https://www.cdc.gov/drugoverdose/epidemic/: centers for disease control and Prevention; December 16, 2016.
- 9.Centers for Disease Control and Prevention Opioid overdose - prescription opioid overdose data. https://www.cdc.gov/drugoverdose/data/overdose.html: centers for disease control and Prevention; December 16, 2016.
- 10.Centers for Disease Control and Prevention. HIV and AIDS--United States, 1981-2000. MMWR Morb Mortal Wkly Rep. 2001;50:430–4.Google Scholar
- 28.New York City Department of City Planning. Population 2010 Census. Accessed on September 30, 2017 at www.nyc.gov.