Narcan in ROSC

Question#: 716

Question:

You get a ROSC on a patient who went VSA due to an overdose, can you give narcan once you get a ROSC if they are still showing signs of an Opiod Overdose?

Answer:

Opioid overdose leads to cardiac arrest because of loss of airway patency and lack of breathing, there is not a significant impact on the heart. Essentially a cardiac arrest occurs in opioid overdose because the heart becomes hypoxic. Therefore, the highest priority prior to cardiac arrest is addressing the airway and ventilation, and if a cardiac arrest occurs the priority is good quality CPR - both compressions and ventilations.

In the latest ILCOR and AHA resuscitation guidelines it is recommended that naloxone not be administered when a healthcare professional is performing a cardiac arrest resuscitation in a suspected opioid overdose, as the evidence does not show a clear benefit from it and it has the potential to detract from providing high quality chest compressions and ventilations, and timely defibrillation - the only interventions that are shown to definitely improve chance of survival.

Lay persons and non-health care public safety officials like police and corrections officers, are recommended to administer naloxone, if available, probably because they are more likely to misidentify cardiac arrest and less likely to perform high quality CPR, including being less likely to have the equipment/willingness to perform the high-quality airway management necessary to reverse hypoxemia associated with opioid deaths.

This all said, there is no contraindication to the administration of naloxone in cardiac arrest. The ALS PCS simply states, “There is no clear role for routine administration of naloxone in confirmed cardiac arrest” for the reasons described above. The RPPEOs position is that paramedics may administer naloxone in a cardiac arrest with suspected opioid overdose if it does not impact negatively on CPR, defibrillation and, if ACP present, administration of other resuscitation medications.

Therefore, you may also administer naloxone in a ROSC patient if you suspect opioid toxicity is the leading cause of the arrest and is playing a role in the patient's condition. Just remember, there may be competing priorities in ROSC patients.