Interpretation of 2023 American Heart Association guideline for the management of patients with cardiac arrest or life-threatening toxicity due to poisoning (Ⅰ): management of neurotoxic substances poisoning_West China Medical Journal

Authors：

XIANG Xinjie ^1,2 , CHU Lili ^1,2 , YAO Peng ^1,2 , XIE Xuxin ^1,2 , LI Yingyi ^1,2 , PENG Aihua ^1,2 ,  CAO Yu ^1,2

1. Department of Emergency Medicine and Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Disaster Medical Center, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

CAO Yu, Email: yuyuer@126.com

Keywords：

Guideline; poisoning; cardiac arrest; resuscitation; extracorporeal membrane oxygenation

DOI：

10.7507/1002-0179.202310267

Video：

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Poisoning is a frequent reason for patients to seek emergency medical attention, and in severe cases, it can result in severe cardiac disease or cardiac arrest. American Heart Association published the guideline for the management of patients with cardiac arrest or life-threatening toxicity due to poisoning in Circulation on September 18, 2023. Based on the literature, this article interprets the suggestions related to neurotoxic substances in this guideline, mainly involving the clinical management of benzodiazepines, opioids, cocaine, local anesthetics, and sympathomimetic substances poisoning. By interpreting the recommended points of the guide in detail, it is hoped that it will be helpful for the diagnosis and treatment of readers.

Citation： XIANG Xinjie, CHU Lili, YAO Peng, XIE Xuxin, LI Yingyi, PENG Aihua, CAO Yu. Interpretation of 2023 American Heart Association guideline for the management of patients with cardiac arrest or life-threatening toxicity due to poisoning (Ⅰ): management of neurotoxic substances poisoning. West China Medical Journal, 2023, 38(11): 1616-1624. doi: 10.7507/1002-0179.202310267 Copy

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2. Lavonas EJ, Akpunonu PD, Arens AM, et al. 2023 American Heart Association focused update on the management of patients with cardiac arrest or life-threatening toxicity due to poisoning: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2023, 148(16): e149-e184.
3. Höjer J, Baehrendtz S, Gustafsson L. Benzodiazepine poisoning: experience of 702 admissions to an intensive care unit during a 14-year period. J Intern Med, 1989, 226(2): 117-122.
4. Gummin DD, Mowry JB, Beuhler MC, et al. 2020 annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 38th annual report. Clin Toxicol (Phila), 2021, 59(12): 1282-1501.
5. Liu S, O’Donnell J, Gladden RM, et al. Trends in nonfatal and fatal overdoses involving benzodiazepines - 38 states and the district of Columbia, 2019-2020. MMWR Morb Mortal Wkly Rep, 2021, 70(34): 1136-1141.
6. Greene SL, Dargan PI, Jones AL. Acute poisoning: understanding 90% of cases in a nutshell. Postgrad Med J, 2005, 81(954): 204-216.
7. An H, Godwin J. Flumazenil in benzodiazepine overdose. CMAJ, 2016, 188(17/18): E537.
8. Penninga EI, Graudal N, Ladekarl MB, et al. Adverse events associated with flumazenil treatment for the management of suspected benzodiazepine intoxication--a systematic review with meta-analyses of randomised trials. Basic Clin Pharmacol Toxicol, 2016, 118(1): 37-44.
9. Dart RC, Borron SW, Caravati EM, et al. Expert consensus guidelines for stocking of antidotes in hospitals that provide emergency care. Ann Emerg Med, 2009, 54(3): 386-394. e1.
10. Sivilotti ML. Flumazenil, naloxone and the ‘coma cocktail’. Br J Clin Pharmacol, 2016, 81(3): 428-436.
11. Gomes T, Ledlie S, Tadrous M, et al. Trends in opioid toxicity-related deaths in the US before and after the start of the COVID-19 pandemic, 2011-2021. JAMA Netw Open, 2023, 6(7): e2322303.
12. Clarke SF, Dargan PI, Jones AL. Naloxone in opioid poisoning: walking the tightrope. Emerg Med J, 2005, 22(9): 612-616.
13. Etherington J, Christenson J, Innes G, et al. Is early discharge safe after naloxone reversal of presumed opioid overdose?. CJEM, 2000, 2(3): 156-162.
14. Whittall JP, Orkin AM, Handford C, et al. Resuscitation simulation among people who are likely to witness opioid overdose: experiences from the SOONER trial. PLoS One, 2022, 17(7): e0270829.
15. Katzman JG, Greenberg NH, Takeda MY, et al. Characteristics of patients with opioid use disorder associated with performing overdose reversals in the community: an opioid treatment program analysis. J Addict Med, 2019, 13(2): 131-138.
16. Pietrusza LM, Puskar KR, Ren D, et al. Evaluation of an opiate overdose educational intervention and naloxone prescribing program in homeless adults who use opiates. J Addict Nurs, 2018, 29(3): 188-195.
17. Walley AY, Doe-Simkins M, Quinn E, et al. Opioid overdose prevention with intranasal naloxone among people who take methadone. J Subst Abuse Treat, 2013, 44(2): 241-247.
18. Tobin KE, Sherman SG, Beilenson P, et al. Evaluation of the staying alive programme: training injection drug users to properly administer naloxone and save lives. Int J Drug Policy, 2009, 20(2): 131-136.
19. Piper TM, Stancliff S, Rudenstine S, et al. Evaluation of a naloxone distribution and administration program in New York city. Subst Use Misuse, 2008, 43(7): 858-870.
20. Pergolizzi JV Jr, Magnusson P, LeQuang JAK, et al. Cocaine and cardiotoxicity: a literature review. Cureus, 2021, 13(4): e14594.
21. Callaway CW, Clark RF. Hyperthermia in psychostimulant overdose. Ann Emerg Med, 1994, 24(1): 68-76.
22. Roberts JR, Quattrocchi E, Howland MA. Severe hyperthermia secondary to intravenous drug abuse. Am J Emerg Med, 1984, 2(4): 373.
23. Catravas JD, Waters IW. Acute cocaine intoxication in the conscious dog: studies on the mechanism of lethality. J Pharmacol Exp Ther, 1981, 217(2): 350-356.
24. Liao X, Zhou Z, Zhou M, et al. Effects of endovascular and surface cooling on resuscitation in patients with cardiac arrest and a comparison of effectiveness, stability, and safety: a systematic review and meta-analysis. Crit Care, 2020, 24(1): 27.
25. Douma MJ, Aves T, Allan KS, et al. First aid cooling techniques for heat stroke and exertional hyperthermia: a systematic review and meta-analysis. Resuscitation, 2020, 148: 173-190.
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