| Summary: | Introduction: The frequency of opioid-related cardiac arrest (ORCA) is increasing across several geographic regions in the United States. Understanding how Maine’s urban and rural areas are affected by ORCA is necessary to improving prevention and treatment of this public health threat. Hypothesis: Patient demographics, clinical features, rurality and survival to emergency department (ED) admission vary significantly between ORCA and non-ORCA. Methods: We evaluated the National Emergency Medical Services Information System data from 2016-2017 for all emergency 911 responses in which emergency medical services (EMS) reported non-traumatic out of hospital cardiac arrest (OOHCA). We defined ORCA as EMS suspected opioid overdose as the primary etiology, or an overdose without established etiology and naloxone administered during cardiopulmonary resuscitation (CPR). Rurality was assigned using Rural-Urban Commuting Area Codes (RUCA). Demographics and arrest-specific factors were compared between ORCA and non-ORCA, followed by logistic regression to evaluate how ORCA was associated with survival to ED admission. Results: There were 3131 EMS responses for OOHCA during the study period. One hundred sixty-eight (5%) patients met the definition of ORCA. These patients were younger (35 ± 9 years vs 62 ± 17 years, p<0.001), less likely to have the reported diagnosis or treatment for chronic medical conditions (p<0.001-0.02), an initial shockable rhythm (12% vs 28%, p<0.001), occur in a public place (13% vs 23%, p=0.02), or be witnessed (38% vs 60%, p<0.001), but more likely to receive bystander CPR (27% vs 16%, p<0.001) and report illicit drug use (19% vs 2%, p<0.001). ORCA was more likely to occur in metropolitan or large rural areas compared to small rural or isolated rural areas (75% vs 25%, p<0.001). After adjusting for age, gender, initial shockable rhythm, witnessed arrest, bystander CPR, and rurality, patients with ORCA had an increased odds of surviving to ED ...
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