Objectives

There are conflicting recommendations for lay rescuer management of patients who are unresponsive and apneic due to opioid overdose. We evaluated the management of such patients at an urban supervised consumption site.

Methods

At a single urban supervised consumption site in Vancouver, BC, we conducted a retrospective chart review and administrative database linkage of consecutive patients who were unresponsive and apneic following witnessed opioid overdose between January 1, 2012 and December 31, 2017. We linked these visits with regional hospital records to define the entire care episode, which concluded when the patient was discharged from the supervised consumption site, ED, or hospital, or died. The primary outcome was successful resuscitation, defined as alive and neurologically intact (ambulatory and speaking coherently, or alert and oriented, or Glasgow Coma Scale 15) at the conclusion of the care episode. Secondary outcomes included mortality and predefined complications of resuscitation.

Results

We collected 767 patients, with a median age of 43 and 81.6% male, with complete follow-up on 763 patients (99.5%). All patients were managed with oxygen and ventilation (100%, 95% CI 0.995–1.0); 715 (93.2%, 95% CI 0.911–0.949) received naloxone; no patients underwent chest compressions (0%, 95% CI 0–0.005). All patients with complete follow-up were alive and neurologically intact at the end of their care episode (100%, 95% CI 0.994–1.0). Overall, 191 (24.9%) patients were transported to hospital, and 15 (2.0%) patients required additional naloxone after leaving the supervised consumption site; 16 (2.1%) developed complications, and 1 patient was admitted to hospital.

Conclusions

At an urban supervised consumption site, all unresponsive, apneic patients with witnessed opioid overdose were successfully resuscitated with oxygen and/or naloxone. No patients required chest compressions.

中文翻译：

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无反应、呼吸暂停、目击阿片类药物过量的院外管理：来自受监督消费场所的病例系列

目标

对于因阿片类药物过量而导致无反应和呼吸暂停的患者，外行施救者管理存在相互矛盾的建议。我们在城市监督消费场所评估了此类患者的管理。

方法

在不列颠哥伦比亚省温哥华的一个城市监管消费场所，我们对 2012 年 1 月 1 日至 2017 年 12 月 31 日期间目睹阿片类药物过量后无反应和呼吸暂停的连续患者进行了回顾性图表审查和管理数据库链接。我们将这些访问与区域医院记录以定义整个护理事件，该事件在患者从受监督的消费场所、急诊室或医院出院或死亡时结束。主要结果是成功复苏，定义为在护理结束时存活且神经功能完好（走动和连贯地说话，或警觉和定向，或格拉斯哥昏迷量表 15）。次要结局包括死亡率和预定义的复苏并发症。

结果

我们收集了 767 名患者，中位年龄为 43 岁，男性占 81.6%，对 763 名患者（99.5%）进行了完整的随访。所有患者均接受氧气和通气管理（100%，95% CI 0.995–1.0）；715 (93.2%, 95% CI 0.911–0.949) 接受了纳洛酮；没有患者接受胸外按压（0%，95% CI 0-0.005）。所有接受完整随访的患者在护理期结束时均存活且神经功能完好（100%，95% CI 0.994–1.0）。总体而言，191 名 (24.9%) 患者被送往医院，15 名 (2.0%) 患者在离开监督消费场所后需要额外的纳洛酮；16 人（2.1%）出现并发症，1 人入院。

结论

在一个城市监督的消费场所，所有目睹阿片类药物过量的无反应、呼吸暂停患者都成功地用氧气和/或纳洛酮复苏。没有患者需要胸外按压。