Cardiac arrest & resuscitation
Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrests in California
Authors' conclusion
In this retrospective cohort study, naloxone administration as part of EMS management of OHCA was associated with increased rates of ROSC and increased survival to hospital discharge when evaluated using propensity score-based models.
Study context
- Population
- Adults (≥18 y) with emergency medical service (EMS)-treated nontraumatic OHCA in 3 Northern California counties, 2015–2023715 presumed drug-related
- Participants
- 8,195 adults
- Exposure
- EMS naloxone administration vs no naloxone
- Naloxonen = 1,165
- Outcome
- Survival to hospital discharge
Methodological detailspropensity score-based models, multicentre (5 EMS agencies, 3 counties)
- Propensity score-based models
- Multicentre (5 EMS agencies, 3 counties)
Main finding
As reported in the abstract
Naloxone vs No naloxoneARD (95% CI)
Nearest neighbor propensity matching
6.2%(2.3%–10.0%)
Inverse propensity-weighted regression adjustment
3.9%(1.1%–6.7%)
- NNT for survival to hospital discharge
- 26
Observational data: associations, not effects.
Secondary outcomes
| Outcome | Absolute risk difference for ROSC (95% CI) | |
|---|---|---|
| Sustained ROSCNaloxone vs No naloxone · nearest neighbor propensity matching | 15.2% (9.9%–20.6%) | |
| Sustained ROSCNaloxone vs No naloxone · inverse propensity-weighted regression adjustment | 11.8% (7.3%–16.4%) | |
| −100102030Difference (linear scale) |
| Outcome | OR for survival to hospital discharge (95% CI) | |
|---|---|---|
| Survival to hospital discharge, presumed drug-related OHCA (subgroup)Effect modification regression model | 2.48 (1.34–4.58) | |
| Survival to hospital discharge, non-drug-related OHCA (subgroup)Effect modification regression model | 1.35 (1.04–1.77) | |
| 0.20.5125OR for survival to hospital discharge (log scale) |
- Sustained return of spontaneous circulation (ROSC) — NNT for ROSC
- 9
Original publication
Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrests in California. JAMA Netw Open. Published 1 August 2024. doi:10.
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