• Saeed Alqahtani, Ziad Nehme, Brett Williams, and Karen Smith.
• Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia; Department of Emergency Medical Care, Prince Sultan Military College of Health Sciences, Al-Dhahran, Saudi Arabia. Electronic address: saeed.alqahtani@monash.edu.
• Resuscitation. 2019 Jan 1; 134: 10-18.

BackgroundOut-of-hospital cardiac arrests (OHCA) precipitated by drug overdose (OD) are becoming an increasing public health problem in developed countries. Empirical data on the global incidence and outcomes are needed to guide preventive and treatment strategies.MethodsWe conducted a systematic review using MEDLINE, Embase, Emcare, All EBM Reviews and CINAHL to identify observational or interventional studies reporting the incidence or outcomes of adult OHCA precipitated by drug OD between 1990 and 2018. Pooled incidence rates per 100,000 person-years and survival outcomes were summarised using random-effects models.ResultsTwelve articles met the eligibility criteria, of which six were from North America, four from Europe and two from Asia. Only two studies reported the incidence of EMS-attended cases. The pooled incidence of EMS-treated OHCA was 1.4 cases per 100,000 person-years. The pooled rate of survival to hospital discharge and survival with favourable neurological outcome was 9% (95% CI: 6%, 12%; I2 = 90%; p < 0.001) and 6% (95% CI: 2%, 13%; I2 = 81%; p < 0.001), respectively. The pooled rate of return of spontaneous circulation was 25% (95% CI: 11%, 41%; I2 = 97%; p < 0.001). Drug OD OHCA was associated with an improvement in the odds of survival to hospital discharge (pooled odds ratio 2.2, 95% CI: 1.7, 2.7; I2 = 0%; p = 0.45).ConclusionThe incidence and survival outcomes of drug OD OHCA varies substantially across regions. Effective strategies designed to reduce incidence and improve survival outcomes are needed.Crown Copyright © 2018. Published by Elsevier B.V. All rights reserved.

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