Can drugs cause cardiac arrest
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Can Drugs Cause Cardiac Arrest?
Introduction to Drug-Induced Cardiac Arrest
Cardiac arrest, a sudden loss of heart function, can be triggered by various factors, including drug use. Both prescription medications and illicit drugs have been implicated in causing cardiac arrest through different mechanisms such as respiratory depression, cardiac toxicity, and adverse drug interactions.
Antiarrhythmic Drugs and Cardiac Arrest
Amiodarone and Lidocaine
Antiarrhythmic drugs like amiodarone and lidocaine are commonly used during cardiac arrest, particularly for shock-refractory ventricular fibrillation or pulseless ventricular tachycardia. However, studies have shown that these drugs do not significantly improve survival rates or neurological outcomes compared to placebo1 2. In a randomized trial, neither amiodarone nor lidocaine resulted in a significantly higher rate of survival to hospital discharge or favorable neurological outcomes1. Similarly, a systematic review found no significant benefit of antiarrhythmic drugs for critical outcomes such as survival to hospital discharge and neurological function2.
Drug Overdose and Cardiac Arrest
Opioid Overdose
Opioid overdose is a leading cause of injury-related death and has been strongly associated with cardiac arrest. Research indicates that opioid overdose increases the likelihood of cardiac arrest during transport to the hospital4. This association is primarily due to respiratory depression and cardiac toxicity caused by opioids, which can lead to fatal arrhythmias and cardiac arrest4.
General Drug Overdose
Drug overdoses, in general, are a significant cause of cardiac arrest. A study found that drug-induced cardiac arrests are associated with worse neurological outcomes compared to those of presumed cardiac etiology3. Additionally, drug overdoses can lead to adverse cardiovascular events (ACVEs) such as myocardial injury, shock, ventricular dysrhythmia, and cardiac arrest, with an incidence rate of up to 9.3% in emergency department patients6.
Drug-Drug Interactions
Intraoperative Cardiac Arrest
Unrecognized drug-drug interactions can also precipitate cardiac arrest. For instance, the combination of multiple drugs during surgery can lead to severe interactions that result in cardiac arrest, as seen in a case where local anesthetics used for an axillary block triggered a cascade of interactions7. This highlights the importance of awareness and monitoring for potential drug-drug interactions in clinical settings.
QTc-Prolonging Drugs
Non-antiarrhythmic drugs that prolong the QTc interval have been linked to an increased risk of cardiac arrest. A study found that hospitalized patients taking these drugs had a significantly higher risk of cardiac arrest, especially when taking higher doses or multiple QTc-prolonging drugs simultaneously10. This risk is further exacerbated by pharmacokinetic interactions with other medications10.
Conclusion
In summary, various drugs, including antiarrhythmic medications, opioids, and other substances, can cause cardiac arrest through different mechanisms. While antiarrhythmic drugs do not significantly improve survival outcomes, drug overdoses and drug-drug interactions pose substantial risks for cardiac arrest. Awareness and careful management of these risks are crucial in preventing drug-induced cardiac arrest.
Sources and full results
Most relevant research papers on this topic
Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest.
Amiodarone and lidocaine did not significantly increase survival or favorable neurologic outcomes compared to placebo in patients with out-of-hospital cardiac arrest due to shock-refractory ventricular fibrillation or pulseless ventricular tachycardia.
RCT
Large Human Trial
Rigorous Journal
Highly CitedEffectiveness of antiarrhythmic drugs for shockable cardiac arrest: A systematic review.
Antiarrhythmic drugs during CPR for shockable cardiac arrest show no significant benefit for critical outcomes of survival at hospital discharge, survival with favorable neurological function, and long-term survival.
Systematic ReviewRigorous JournalAbstract 274: Drugs and Cardiac Arrest: Suffocate the Brain, Spare the Body?
Drug-induced cardiac arrests are associated with worse neurologic outcomes than presumed cardiac etiology cardiac arrests, despite similar survival rates.
Observational StudyRigorous JournalAssociation of Cardiac Arrest With Opioid Overdose in Transport
Opioid overdose is associated with an increased incidence of cardiac arrest in transport in the United States.
Observational StudyOut-of-hospital cardiac arrest survival in drug-related versus cardiac causes in Ontario: A retrospective cohort study
Drug-related cardiac arrest patients are less likely to receive bystander resuscitation or have initial shockable rhythms, but are more likely to survive after accounting for survival predictors.
Observational StudyRigorous JournalIncidence of adverse cardiovascular events in adults following drug overdose.
Adverse cardiovascular events (ACVEs) may occur in up to 9.3% of adult patients with acute drug overdose, requiring further study on optimizing interventions to prevent these events.
Observational StudyUnrecognized drug-drug interactions: a cause of intraoperative cardiac arrest?
Unrecognized drug-drug interactions can cause intraoperative cardiac arrest, and physicians should be aware of these interactions to prevent such complications.
Case ReportIntravenous vs. Intraosseous Administration of Drugs During Cardiac Arrest: A Systematic Review.
Intravenous access is favoured during cardiac arrest, but the evidence is very low and there is no significant interaction between the route of access and study drug outcomes.
Systematic ReviewRigorous JournalHighly Cited2018 American Heart Association Focused Update on Advanced Cardiovascular Life Support Use of Antiarrhythmic Drugs During and Immediately After Cardiac Arrest: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
Antiarrhythmic drugs may improve patient outcomes in shock-refractory ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest, but their effectiveness remains unclear.
Very Rigorous JournalHighly CitedIn-hospital cardiac arrest is associated with use of non-antiarrhythmic QTc-prolonging drugs.
Non-antiarrhythmic QTc-prolonging drugs in hospitalized patients with multiple underlying diseases increase the risk of cardiac arrest, with dose-related effects and pharmacokinetic drug-drug interactions enhancing the risk.
Observational StudyHighly Cited