-
Sporer KA et al. Out-of-hospital treatment of opioid overdoses in an urban setting. Acad Emerg Med 1996;3(7):660-7. PubMed
| Level of Evidence |
4 |
| Study Design |
Retrospective, Cohort Study |
| Sample Size |
N = 726
|
| Population |
Adults with presumed opioid overdose
|
| Interventions |
Prehospital administration of naloxone
|
| Results |
- Most patients (609/726, 85.4%) had an initial
pulse and blood pressure (BP).
- Most (94%) of this group responded to naloxone
and all were transported. Of the remainder, 101 (14%) had obvious signs of
death and 16 (2.2%) were in cardiopulmonary arrest without obvious signs of
death. Of the patients in full arrest, 2 had return of spontaneous circulation
but neither survived.
- Of the 609 patients who had initial BPs, 487
(80%) received naloxone i.m. (plus bag-valve-mask ventilation) and 122 (20%)
received the drug i.v. Responses to naloxone were similar; 94% i.m. vs 90% i.v.
- Of 443 patients transported to the country
hospital, 12 (2.7%) were admitted.
- The admitted patients (n=12) had noncardiogenic
pulmonary edema (n = 4), pneumonia (n = 2), other infections (n = 2),
persistent respiratory depression (n = 2), and persistent alteration in mental
status (n = 2).
- The patients with pulmonary edema were clinically
obvious upon ED arrival.
- Hypotension was never noted
and bradycardia was seen in only 2% of the presumed-opioid-overdose population
|
| Conclusions |
The majority of the opioid-overdose patients who had initial BPs
responded readily to naloxone, with few patients requiring admission.
Noncardiogenic pulmonary edema was uncommon and when present, hypoxia was
evident upon arrival to the ED. Naloxone administered IM in conjunction with
bag-valve-mask ventilation was effective in this patient population. The
opioid-overdose patients in cardiopulmonary arrest did not survive.
|
| Location |
Department of Emergency Services, University of California, Los Angeles,
School of Medicine, USA
|
-
Osterwalder JJ. Patients intoxicated with heroin or heroin mixtures: how long should they be monitored. Eur J Emerg Med 1995;2(2):97-101. PubMed
| Level of Evidence |
2b |
| Study Design |
Prospective, Single center, Cohort study
|
| Sample Size |
N = 160
|
| Population |
Adults
intoxicated with heroin or heroin mixtures who survived to the hospital from
January 1, 1991 to December 31, 1992
|
| Inclusion Criteria |
GCS < 15 and respiratory depression of <
12 /min, improvement in condition following naloxone, and confirmed drug
intoxication
|
| Interventions |
Naloxone (Narcan) |
| Primary Endpoint |
To find out the time
interval during which delayed life-threatening complications become manifest,
such as pulmonary edema or relapse into respiratory depression or coma after
naloxone treatment. |
| Results |
- Of the 538 intoxications, 6 out of the 169
intoxications resulted in pulmonary edema (incidence of 3.6%. 160 outpatients who lived were assessed.
- The results of our investigation showed no rehospitalization
owing to pulmonary edema or coma, but one death, outside the hospital, owing to
delayed pulmonary edema.
- This delayed complication had an incidence of
0.6% (95% confidence interval 0-3.8%). A reintoxication could be excluded in
this patient. Based on reliable report, the pulmonary edema occurred between
approximately 2 1/4 and 8 1/4 hours after intoxication.
- In the literature, only two
cases of delayed pulmonary edema have been reported with reliable time
statements (4 and 6 h after hospitalization).
|
| Conclusions |
"We therefore conclude that surveillance for at least 8 h is essential
after successful treatment to exclude delayed pulmonary edema in patients
intoxicated with heroin or heroin mixtures."
|
| Location |
Department of Emergency Medicine and Surgery, Kantonsspital St Gallen,
Switzerland.
|
-
Smith DA et al. Is admission after intravenous heroin overdose necessary? Ann Emerg Med 1992;21(11):1326-30. PubMed
| Level of Evidence |
4 |
| Study Design |
Retrospective chart review at a single center
|
| Sample Size |
N = 124
|
| Population |
Adults found to have IV heroin overdose
|
| Results |
- There were five deaths in the ED, 3 who developed
pulmonary edema, 12 hospital admissions, and 107 patients who were discharged
home. Neither delayed onset of pulmonary edema nor recurrence of respiratory
depression was observed.
- Of the 115 persons having succumbed to a narcotic
overdose, eight had been seen previously at this hospital for a heroin
overdose.
- There is no evidence that
any of these eight deaths would have been prevented by a 24-hour hospital
observation period.
|
| Conclusions |
"Complications arising from an IV overdose of heroin are usually evident
on arrival in the ED or shortly thereafter. On retrospective review we have
found no evidence that admission to the hospital and 24 hours of observation
are of benefit to patients who are awake, alert, and lacking evidence of
pulmonary complications after an IV heroin overdose."
|
| Location |
Division of Emergency Medicine, Texas A&M University College of
Medicine, College Station, Texas
|
| Comments |
This study also reviewed death certificates to
compare to hospital records.
|
-
Bertini G et al. Role of a prehospital medical system in reducing heroin-related deaths. Crit Care Med 1992;20(4):493-8. PubMed
| Level of Evidence |
4 |
| Study Design |
Restrospective Study
|
| Sample Size |
N = 126
|
| Population |
Adults with heroin overdose from January 1, 1984
through December 31, 1987
|
| Primary Endpoint |
To determine if the prehospital emergency medical system of Florence,
the capital of Tuscany (and the only one operating in Italy during the study
period), affected this lower mortality rate.
|
| Results |
- Fifty-two (41.3%)
patients were in respiratory arrest, and seven (5.6%) patients were in
cardiorespiratory arrest.
- The prehospital
mortality rate was 1.6%, the inhospital mortality rate related to acute pulmonary edema was 0.8% (or 1-patient), and the
overall mortality rate was 2.4%.
- During the period
considered, the number of heroin overdose-related interventions increased
significantly, as did the number of heroin overdoses complicated by respiratory
arrest or by cardiorespiratory arrest, but the mortality rate remained low.
|
| Location |
Istituto di Clinica Medica I, Universitá di Firenze, Italia |
|
