Improving outcomes in opioid-associated cardiac arrest

As opioid misuse has risen across the United States, so opioid-associated out-of-hospital cardiac arrest, which unique clinical features and management implications, according to a new scientific statement from American Heart Association (AHA).“Opioid-associated arrests have distinct pathophysiology require different care compared with traditional events as result of an ischemia or heart failure,” said Cameron Dezfulian, MD, vice chair AHA senior faculty in departments critical adult coronary disease at Texas Children’s Hospital.“Pharmacists can bring awareness team patients who are known issue opioids play active role appropriate these time discharge.”Risk factorsThe statement, was published Circulation March 2021, is divided into prehospital postresuscitation arrest. noted that more likely happen home, be unwitnessed, occur younger adults between ages 20 59 years.The includes list risk factors for arrest (see sidebar). These brain hypoxia, progressive hypoxia thought precede cessation output.Risk •History other substance alcohol use disorder•Comorbid medical mental health disorders•High long-term dose potent synthetics•Concurrent benzodiazepine antidepressant use•Being naive•Recent incarceration inpatient hospitalization loss tolerance•Recent release abstinence-based treatment program•Enrollment dependence program•History prior poisoning•Social isolationSource: Circulation. 2021;143:e836–e870.This important implications CPR, current CPR recommendations focus on compression-only method, would not beneficial those whom reoxygenation essential. Therefore, rescue breaths addition high-quality chest compressions preferable resuscitation arrest.The naloxone also discussed patients.Interventions discharge beyondDezfulian various ways pharmacists take after He many disorders lose their tolerance drug acute period extremely high dying if they similar doses again. “Pharmacists should aware this ‘loss tolerance’ work discharge,” Dezfulian.Dezfulian suggested start patient agent like buprenorphine (Suboxone—Indivior) methadone—although methadone much less safe, Dezfulian—or refer immediately abuse program.Dispensing training family members its proper another intervention consider, Dezfulian said.In section increasing potential life-saving ability, recommends providers 1) determine whether state permits prescribe dispense it under standing order (i.e., without patient-specific order) collaborative practice agreement; 2) increased overdose friends; 3) covered by insurance available low no cost patients.Although data exist providing basic life support education families (with emphasis need provide breathing), reasonable intervention.Pharmacists identifying increase patient’s overdose, ensure following guidelines prescribing opioids, make most prescription programs. (AHA). “Opioid-associated Hospital. discharge.” Risk patients. The years. output. 2021;143:e836–e870. isolation Source: This Interventions Dezfulian. program. Dispensing said. In Although intervention. Pharmacists