From the Guidelines
The use of naloxone in cardiac arrest trials is not recommended as a standard practice, but it may be considered in cases where opioid overdose is suspected as the cause of the arrest. According to the 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1, standard resuscitative measures should take priority over naloxone administration, with a focus on high-quality CPR. The guidelines suggest that lay and trained responders should not delay activating emergency response systems while awaiting the patient’s response to naloxone or other interventions 1.
Some key points to consider in the management of cardiac arrest include:
- Maintaining rescue breathing or bag-mask ventilation until spontaneous breathing returns 1
- Continuing standard BLS and/or ACLS measures if return of spontaneous breathing does not occur 1
- Administering naloxone in cases of suspected opioid overdose with respiratory arrest, in addition to providing standard BLS and/or ACLS care 1
- Prioritizing high-quality CPR over naloxone administration in cardiac arrest cases where opioid overdose is not suspected 1
It is essential to note that the guidelines emphasize the importance of focusing on established, evidence-based resuscitation practices in cardiac arrest management, rather than relying on naloxone as a standard treatment 1. By prioritizing high-quality CPR and standard resuscitative measures, healthcare providers can optimize outcomes for patients in cardiac arrest, while also considering the potential benefits of naloxone in specific cases where opioid overdose is suspected.
From the FDA Drug Label
CLINICAL PHARMACOLOGY Complete or Partial Reversal of Opioid Depression Naloxone prevents or reverses the effects of opioids including respiratory depression, sedation and hypotension. PRECAUTIONS General In addition to naloxone, other resuscitative measures such as maintenance of a free airway, artificial ventilation, cardiac massage, and vasopressor agents should be available and employed when necessary to counteract acute opioid poisoning
The FDA drug label does not answer the question.
From the Research
Recent Evidence on Naloxone in Cardiac Arrest Trials
- The use of naloxone in cardiac arrest has been studied in various trials, with a focus on its effectiveness in reversing opioid overdose 2, 3, 4, 5, 6.
- A 2021 study published in Circulation found that naloxone can be administered by emergency medical personnel, trained laypeople, and the general public with dispatcher instruction to prevent cardiac arrest in cases of suspected opioid overdose 2.
- A 2010 study published in Resuscitation found that naloxone administration during cardiac arrest in suspected opioid overdosed patients was associated with a change in cardiac rhythm, with 42% of patients showing improvement in electrocardiogram (EKG) rhythm 3.
- A 2017 systematic review published in Annals of Internal Medicine found that higher-concentration intranasal naloxone (2 mg/mL) seems to have efficacy similar to that of intramuscular naloxone for reversal of opioid overdose, with no difference in adverse events 4.
- A 2021 study published in Resuscitation developed simple decision instruments that can identify patients whose out-of-hospital cardiac arrest (OHCA) precipitant was occult opioid overdose, which may be used to guide selective administration of naloxone in OHCA resuscitations 5.
- A 2024 study published in The Journal of Emergency Medicine found that OHCA patients who received naloxone had similar outcomes compared to those who received usual care, despite being younger and having fewer comorbidities 6.
Key Findings
- Naloxone can be effective in reversing opioid overdose and improving cardiac rhythm in cases of suspected opioid overdose 2, 3.
- The route of administration and dosing of naloxone may affect its efficacy and safety 4.
- Decision instruments can be used to identify patients whose OHCA precipitant was occult opioid overdose, which may guide selective administration of naloxone 5.
- Naloxone administration may not be associated with improved outcomes in OHCA patients, despite its potential benefits in reversing opioid overdose 6.