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Abstract

Aim: Cardiac arrest due to opioid toxicity is a leading cause of life-years lost in many countries. Since the pathophysiology of cardiac arrest from opioid toxicity is different than primary cardiac etiologies, we sought to identify opioid-specific resuscitative interventions demonstrating benefit. Methods: We searched Medline, EMBASE, CENTRAL, and the Web of Science (September 2024) for randomized or observational studies exam-ining the benefit of opioid-specific advanced life support-level therapies for cardiac arrest. The primary and secondary outcomes were favourable neurological outcomes and survival at 30-days or hospital discharge, respectively. Risk of Bias and Certainty of Evidence were assessed with the ROBINS-I tool and GRADE methodology, respectively. Results: We reviewed 1051 studies; six observational studies met criteria for analysis. Five studies examined the association of naloxone and out-comes (three included undifferentiated cases, one included non-shockable initial rhythm cases, and two included cases with “drug overdose”): two reported that naloxone was associated with improved outcomes, and three did not detect an association. One additional study examined the asso-ciation of bicarbonate and outcomes, reporting that bicarbonate was associated with decreased survival at hospital discharge. All studies were lim-ited by serious risk of bias and indirectness, with the certainty of evidence judged to be very low. No studies exclusively examined opioid-related cases. Conclusions: There is currently no evidence demonstrating benefit for any advanced life support interventions specific to treating cardiac arrest from opioid toxicity. Data examining naloxone for undifferentiated or “drug-related” cardiac arrest are heterogenous with high risk of bias and low certainty of evidence.