Question: Could you please give clarification - On a VSA of a suspected opioid overdose, can we leave after the 1st analysis? Half my co-workers say yes and the other half says no, that you must stay to complete 4 analysis. I understand that early transport can be considered in medication overdose/toxicology. Where we are having difficulty with the interpretation of the protocol is "In cardiac arrest associated with opioid overdose, continue standard medical cardiac arrest directive. There is no clear role for routine administration of naloxone in confirmed cardiac arrest". Some medics are saying that the "continue standard medical arrest directive " means to complete 4 analysis. My interpretation is, no narcan and continue protocol, which is to consider early departure. Thanks

We can understand the confusion regarding the wording under Clinical Considerations, In cardiac arrest associated with opioid overdose, continue standard medical cardiac arrest directive. There is no clear role for routine administration of naloxone in confirmed cardiac arrest. Here, standard medical cardiac arrest medical directive means to treat only within this Medical Directive.

As such, opioid overdose does NOT fall into the consider very early transport after the first analysis contained within the Clinical Considerations.  This is reserved for other toxicological overdoses whereby specific antidotes or other treatments may be available in the ED.

Now for some updated information. The  2020 AHA Part 3: Adult Basic and Advanced Life Support Guidelines Top 10 take home messages  state that The opioid epidemic has resulted in an increase in opioid-associated out-of-hospital cardiac arrest, with the mainstay of care remaining the activation of the emergency response systems and performance of high-quality CPR. 

In situations where resources permit, naloxone can be considered in cardiac arrest situations whereby opioid toxicity is the likely culprit.  It should be noted that naloxone administration is NOT the expectation.  Paramedics should not sacrifice other priorities in cardiac arrest care such as quality CPR, defibrillation and ventilation to administer naloxone.  There is no evidence for the administration of naloxone in cardiac arrest and the recommendation within the AHA Guidelines is based on expert consensus only.

• • From AHA 2020 Guidelines Special Circumstances: Opioid Toxicity Section:

Because there are no studies demonstrating improvement in patient outcomes from administration of naloxone during cardiac arrest, provision of CPR should be the focus of initial care. Naloxone can be administered along with standard ACLS care if it does not delay components of high-quality CPR.

Cardiac/Circulation,Level of Consciousness,Medical Cardiac Arrest,Opioid Toxicity

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