Consider Overdose in All Out-of-Hospital Cardiac Arrests

The opioid epidemic continues unabated and there are early indications that the COVID-19 pandemic is exacerbating substance use disorder due to increased anxiety, financial distress, and isolation. Some overdoses are obvious on presentation while others may present as out-of-hospital cardiac arrest and be unrecognized.

To characterize occult overdoses these investigators performed a comprehensive postmortem analysis of a case series of 767 patients (ages 18 to 90 years) with out-of-hospital cardiac arrest over 7 years in San Francisco. An expert panel decided the cause of death in all cases; occult overdose required a lethal toxicologic dose without any other cause found on autopsy.

Overall, 17% of out-of-hospital cardiac arrests were determi…