Cardiac arrest & resuscitation
Validation of the naloxone cardiac arrest decision instrument for identifying opioid-associated cardiac arrests
Authors' conclusion
In this external validation cohort, NACARDI had a sensitivity and specificity sufficiently high to aid in the real-time identification of occult OA-OHCA in the field.
Study context
- Population
- Adults (≥18 years) with emergency medical service (EMS)-attended OHCA death without suspected overdose or known cause and with a coroner record, Ontario, Canada, 2020–2021of 2904 OHCA without obvious cause
- Participants
- 791 adults
- Comparison
- NACARDI-60 vs NACARDI-50 for identifying occult opioid-associated OHCA
- Outcome
- Coroner-adjudicated cause of death (occult OA-OHCA)
Methodological detailsretrospective, external validation
- Retrospective
- External validation
Performance
As reported in the abstract
Occult OA-OHCA (121 [15.3 %] of 791)
| Test or model | Sensitivity | Specificity | PPV | NPV |
|---|---|---|---|---|
| NACARDI-60 | 82.6 % (95 %CI 74.9-88.4 %)Sensitivity on a scale from 0 to 100 percent | 77.1 % (95 %CI 73.8-80.1 %)Specificity on a scale from 0 to 100 percent | 39.4 % (95 %CI 33.6-45.5 %) | 96.1 % (95 %CI 94.1-97.4 %) |
| NACARDI-50 | 63.6 % (95 %CI 54.4-72.2 %)Sensitivity on a scale from 0 to 100 percent | 89.3 % (95 %CI 86.7-91.5 %)Specificity on a scale from 0 to 100 percent | 51.7 % (95 %CI 43.4-59.9 %) | 93.2 % (95 %CI 90.9-95.0 %) |
Sensitivity
NACARDI-6082.6 % (95 %CI 74.9-88.4 %)
NACARDI-5063.6 % (95 %CI 54.4-72.2 %)
Sensitivity on a scale from 0 to 100 percentSpecificity
NACARDI-6077.1 % (95 %CI 73.8-80.1 %)
NACARDI-5089.3 % (95 %CI 86.7-91.5 %)
Specificity on a scale from 0 to 100 percentPPV
NACARDI-6039.4 % (95 %CI 33.6-45.5 %)
NACARDI-5051.7 % (95 %CI 43.4-59.9 %)
NPV
NACARDI-6096.1 % (95 %CI 94.1-97.4 %)
NACARDI-5093.2 % (95 %CI 90.9-95.0 %)
Original publication
Validation of the naloxone cardiac arrest decision instrument for identifying opioid-associated cardiac arrests. Resuscitation. Published 6 October 2025. doi:10.
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