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Out-of-hospital management of unresponsive, apneic, witnessed opioid overdoses: a case series from a supervised consumption site

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Abstract

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.

Résumé

Objectifs

Il existe des recommandations contradictoires concernant la prise en charge par des secouristes non professionnels des patients qui ne réagissent pas et sont apnéiques en raison d'une surdose d'opioïdes. Nous avons évalué la prise en charge de ces patients dans un site urbain de consommation supervisée.

Méthodes

Dans un seul site de consommation supervisée urbain à Vancouver, en Colombie-Britannique, nous avons effectué un examen rétrospectif des dossiers et un couplage de bases de données administratives de patients consécutifs qui étaient insensibles et apnéiques après avoir été témoins d'une surdose d'opioïdes entre le 1er janvier 2012 et le 31 décembre 2017. Le résultat primaire était la réussite de la réanimation, définie comme étant vivante et neurologiquement intacte (ambulatoire et parlant de manière cohérente, ou alerte et orientée, ou échelle de coma de Glasgow 15) à la fin de l'épisode de soins. Les résultats secondaires comprenaient la mortalité et les complications prédéfinies de la réanimation.

Résultats

Nous avons recueilli 767 patients, avec un âge médian de 43 ans et 81,6 % d'hommes, avec un suivi complet de 763 patients (99,5 %). Tous les patients ont été pris en charge avec de l'oxygène et la ventilation (100 %, IC à 95 % : 0,995-1,0) ; 715 (93,2 %, IC à 95 % : 0,911-0,949) ont reçu de la naloxone ; aucun patient n'a subi de compressions thoraciques (0 %, IC à 95 % : 0-0,005). Tous les patients ayant fait l’objet d’un suivi complet étaient vivants et intacts sur le plan neurologique à la fin de leur épisode de soins (100 %, IC à 95 % : 0,994-1,0). Dans l'ensemble, 191 (24,9 %) patients ont été transportés à l'hôpital, et 15 (2,0 %) patients ont eu besoin de naloxone supplémentaire après avoir quitté le site de consommation supervisée ; 16 (2,1 %) ont développé des complications, et 1 patient a été admis à l'hôpital.

Conclusions

Dans un centre de consommation supervisée urbain, tous les patients apnéiques non réceptifs ayant été témoins d’une surdose d’opioïdes ont été réanimés avec succès avec de l’oxygène et/ou de la naloxone. Aucun patient n’a eu besoin de compressions thoraciques.

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Acknowledgements

We would like to sincerely thank Christopher Mah, Richa Sharma, Fiona O’Sullivan and Jeff West for their contributions to this project.

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, University Health Network, ON, Toronto, Canada

    Adrianna Rowe

  2. Division of Clinical Pharmacology and Toxicology, Department of Medicine, University of Toronto, Toronto, ON, Canada

    Adrianna Rowe

  3. Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada

    Andrew Chang, Emily Lostchuck, Frank Scheuermeyer, Jessica Moe, Paul Clerc & Roy Purssell

  4. Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    Kathleen Lin & Connor McSweeney

  5. Department of Emergency Medicine, St. Paul’s Hospital, Vancouver, BC, Canada

    Frank Scheuermeyer

  6. Faculty of Medicine, Queen’s University, Kingston, ON, Canada

    Victoria McCann

  7. British Columbia Centre for Disease Control, Vancouver, BC, Canada

    Jane Buxton & Jessica Moe

  8. School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada

    Jane Buxton

  9. Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC, Canada

    Jessica Moe & Roy Purssell

  10. Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada

    Raymond Cho

  11. Department of Internal Medicine, University of Western Ontario, London, ON, Canada

    Andy Jiang

  12. British Columbia Drug and Poison Information Centre, Vancouver, BC, Canada

    Roy Purssell

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  1. Adrianna Rowe
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Correspondence to Adrianna Rowe.

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Rowe, A., Chang, A., Lostchuck, E. et al. Out-of-hospital management of unresponsive, apneic, witnessed opioid overdoses: a case series from a supervised consumption site. Can J Emerg Med 24, 650–658 (2022). https://doi.org/10.1007/s43678-022-00326-9

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  • DOI: https://doi.org/10.1007/s43678-022-00326-9

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