Narcan for Cardiac Arrest

Jeff,  A long time listener from Eagle Valley wrote in with the following question:

"We are seeing more arrests from heroin overdoses, should we be using narcan early in those cases, or following our cardiac arrest protocol?"

Jeff, great question.

It seems logical that since the arrest is caused by the heroin overdose, we should use the antidote early to correct the problem. I have seen the same approach in cases of hypoglycemia causing cardiac arrest; people give D50 to correct the  initial problem, hoping it will improve the cardiac arrest condition.

The quick answer for this, we should be following the cardiac arrest protocol.

Here is the AHA text from the section of the 2010 guidelines for CPR and Cardiac Arrest.

Naloxone has no role in the management of cardiac arrest.

Here is the rationale that I use when asked "Why not use glucose or narcan when you know exactly what caused the cardiac arrest."

Hypoglycemia and heroin are indirect causes of cardiac arrest. They have little if any direct effect on the heart. Therefor, reversing them does not counteract some direct effect that is causing the cardiovascular problem. They cause respiratory arrest, which leads to hypoxia and then cardiac arrest. So, if the person is in respiratory arrest, it makes sense to reverse the problem ( give D50 or Narcan). Once they are in cardiac arrest, you are dealing with problems that are not going to respond to reversing the hypoglycemia or heroin.

Said another way, giving narcan in a cardiac arrest may increase their respiratory rate, but you still have no cardiac activity to work with,  so you should be treating per cardiac arrest protocol.

There are some conditions that have a direct effect on the heart. Those we should be treating if we are suspicious they caused the cardiac arrest. These are commonly referred to as the "H's and T's". If the high potassium caused the cardiac arrest, we should treat the high potassium since it has a direct effect on the heart.

References:
I found only 3 articles about narcan in cardiac arrest. One was a case report of a person who arrested from a pain medication overdose. She got ROSC after narcan but did not live. The other is a retrospective look at care provided over a long time. They found 36 cases where the patient got Narcan because of suspicion of overdose. 15 had a change in their EKG, but there is no comment about if the people lived or even got ROSC.

So for now, follow protocol and look for the "H's and T's", of which heroin and hypoglycemia are "H"s".





Thanks to Vikki Peckman, Doug Thompson and Kyle Strege. All knew that in a newborn, the right arm is the most accurate assessment of the oxygen state of the child since the left arm ( and legs) carries blood from the ductus as well as the aorta so the oxygenation is mixed and lower than the blood going to the head and right arm.