Incidence of mortality due to rebound toxicity after 'treat and release' practices in prehospital opioid overdose care: a systematic review
Incidence of mortality due to rebound toxicity after 'treat and release' practices in prehospital opioid overdose care: a systematic review
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DOI：
10.1136/emermed-2018-207534
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发表时间：
2019-04-01
影响因子：
3.1
通讯作者：
Butler, Michael B.
中科院分区：
文献类型：
--
作者：
Greene, Jennifer Anne;Deveau, Brent J.;Butler, Michael B.
2015年，加拿大宣布阿片类药物过量死亡为公共卫生危机。传统上，过量服用由紧急医疗服务(EMS)管理的阿片类药物的患者会使用阿片拮抗剂纳洛酮进行治疗，提供呼吸支持，然后被送往医院。然而，某些EMS机构允许已经从阿片类药物过量逆转的患者拒绝运输，如果患者表现出这样做的能力的话。关于这种做法安全性的证据有限。因此，我们的目的是查阅现有的文献，以确定EMS治疗和释放后48小时内因纳洛酮治疗后疑似反弹阿片中毒而发生的严重不良事件和死亡率。方法2017年5月11日在PubMed、Cochrane Central、Embase和CINHAL进行系统检索。报告了院前使用纳洛酮治疗的患者的结果并在现场公布的研究包括在内。对现场死亡率和不良事件发生率进行分析。结果剔除重复后共筛选出1401条记录。对18篇全文研究进行了综述，其中7篇入选。没有人被发现存在高风险的偏见。在大多数研究中，海洛因是过量服药的来源。48小时内死亡的情况很少见，4912名患者中只有4人死亡。0.081%。在这七项研究中。只有一项研究报道了不良事件，在71名出院患者的样本中没有发现不良事件的发生。结论纳洛酮治疗EMS后现场释放的患者因疑似反弹毒性而导致的死亡或严重不良事件很少见。然而，涉及长效阿片类药物的研究很少，没有研究涉及芬太尼。
Introduction Death due to opioid overdose was declared a public health crisis in Canada in 2015. Traditionally, patients who have overdosed on opioids that are managed by emergency medical services (EMS) are treated with the opioid antagonist naloxone, provided ventilatory support and subsequently transported to hospital. However, certain EMS agencies have permitted patients who have been reversed from opioid overdose to refuse transport, if the patient exhibits capacity to do so. Evidence on the safety of this practice is limited. Therefore, our intent was to examine the available literature to determine mortality and serious adverse events within 48 hours of EMS treat and release due to suspected rebound opioid toxicity after naloxone administration.Methods A systematic search was performed on 11 May 2017 in PubMed, Cochrane Central, Embase and CINHAL. Studies that reported on the outcome of patients treated with prehospital naloxone and released at the scene were included. Analyses for incidence of mortality and adverse events at the scene were conducted. Risk of bias and assessment of publication bias was also done.Results 1401 records were screened after duplicate removal. Eighteen full-text studies were reviewed with seven selected for inclusion. None were found to be high risk of bias. In most studies, heroin was the source of the overdose. Mortality within 48 hours was infrequent with only four deaths among 4912 patients. 0.081%. in the seven studies. Only one study reported on adverse events and found no incidence of adverse events from their sample of 71 released patients.Conclusion Mortality or serious adverse events due to suspected rebound toxicity in patients released on scene post-EMS treatment with naloxone were rare. However, studies involving longer-acting opioids were rare and no study involved fentanyl.