Barriers to bystander interventions in suspected opioid-associated out-of-hospital cardiac arrests: A multiple methods study of 9-1-1 calls

Introduction

Opioid-associated out-of-hospital cardiac arrests (OA-OHCA) is a significant problem in the United States. Layperson interventions, including bystander CPR and naloxone may improve survival, but barriers may differ compared to other OHCA. This study aims to describe characteristics of 9-1-1 callers and patients in suspected OA-OHCAs and identify barriers to B-CPR and naloxone administration.

Methods

This was a retrospective multiple methods study of transcribed 9-1-1 calls for suspected OHCA from two counties in North Carolina (5/2022–12/2023). Adult, non-traumatic OHCAs were included. Data were analyzed using descriptive statistics and Student’s t-test/Chi². We used thematic analysis and a combined deductive and inductive approach.

Results

Patients with suspected OA-OHCA were younger than non-suspected OA-OHCA patients (39 vs 58 years [p < 0.01]). Most patients were in a residence, however, this percentage was smaller in suspected OA-OHCA compared with non-suspected OA-OHCA (68 % vs 88 % [p < 0.01]). Most callers in the suspected OA-OHCA group were a friend of the patient (35 %), whereas most callers in the non-suspected OA-OHCA population were a family member (34 %) [p < 0.01]. Qualitative barriers unique to suspected OA-OHCA included: conflicting responsibilities, fear of drugs, and fear of the patient. Naloxone-specific barriers included lack of availability and lack of knowledge of use.

Conclusion

We found significant differences in demographics between suspected OA-OHCA compared with non-suspected OA-OHCA. We also identified unique barriers in this population as well as previously described barriers which may be amplified in the setting of suspected drug use. A different approach towards cardiac resuscitation may be needed to maximize treatment and survival.