Abstract Details

Title Neurological Injury and Outcomes in Fentanyl-related Cardiac Arrest

Topic Neuro Trauma and Critical Care

Presentation(s) P14 - Poster Session 14 (11:45 AM-12:45 PM)

Poster/Presentation
Number 1-004

Objective Determine if fentanyl-related (FR) cardiac arrest is associated with worse outcomes and neurological injury compared to other opioid-related (OpR) cardiac arrest (CA).

Background In San Francisco, fentanyl is the primary drug responsible for fatal overdoses. Identifying clinical differences in this cause of CA is imperative for guiding management and prognostication.

Design/Methods We retrospectively reviewed medical records from adult patients with sustained return of spontaneous circulation after out-of-hospital CA admitted to an academic safety net hospital from 2019 to 2021. Admission toxicology urine or blood tests were reviewed for presence of fentanyl, opiates, stimulants, or benzodiazepines. Malignant EEG was defined as complete suppression, burst suppression, seizure, or periodic discharges. Good outcome was defined as a Cerebral Performance Category score of 1-2 at discharge.

Results Two-hundred and thirty-eight subjects underwent neurological prognostication. Sixty-one (25.8%) subjects had good outcome. Thirty-six (15.1%) subjects tested positive for fentanyl and 13 for other opioids (5.5%). The FR CA group was younger than OpR and non-opioid related (NOpR) groups (42.06 ± 12.2 vs. 55.1 ± 12.7 vs. 63.4 ± 17.6, p<0.001). The FR group had lower rate of bystander CPR (19.4% vs 38.5% vs 44.3%, p=.02) and shockable rhythms (2.9% vs. 16.7% vs 25.9%, p<0.01). Subjects in the FR and OpR groups were more often unhoused or marginally housed than the NOpR group (38.5%, 23.5%, and 9.5%, p=.002). Malignant EEG and burst suppression were more common in the FR group (77.4% and 54.5% vs. 33.3% and 0% in OpR and 64.7% and 39.8% in NOpR, p=0.047 and p=0.012, respectively). There were no differences in good outcome (20% vs 38.5% vs. 26.1%, p=0.4) or mortality (71.4% vs. 53.8% vs. 67.6%, p=0.5).

Conclusions Fentanyl-related cardiac arrest may be associated with worse brain injury measured with EEG criteria than other opioid-related cardiac arrest, however neurological outcomes and mortality were comparable.

Authors/Disclosures
Matheus Otero, MD (Mount Sinai West) PRESENTER	Dr. Otero has nothing to disclose.
Jonathan Shih (University of California, San Francisco)	Jonathan Shih has nothing to disclose.
Edilberto Amorim, MD	The institution of Dr. Amorim has received research support from American Heart Association. The institution of Dr. Amorim has received research support from Society of Critical Care Medicine. The institution of Dr. Amorim has received research support from Zoll Foundation. The institution of Dr. Amorim has received research support from Hellman Foundation. The institution of Dr. Amorim has received research support from Regents of the University of California. The institution of Dr. Amorim has received research support from Citizens United Against Epilepsy. The institution of Dr. Amorim has received research support from Regents of the University of California. The institution of Dr. Amorim has received research support from American Heart Association. The institution of Dr. Amorim has received research support from NIH. The institution of Dr. Amorim has received research support from Department of Defense. The institution of Dr. Amorim has received research support from Department of Defense. The institution of Dr. Amorim has received research support from American Heart Association.

��ɫ��

��ɫ��