Nationwide population-based study of poisoning-induced out-of-hospital cardiac arrest in South Korea

Abstract

ObjectiveTo evaluate the characteristics of poisoning-induced out-of-hospital cardiac arrest (pOHCA) and the factors influencing survival to discharge and good neurological outcomes using a nationwide, population-based database.DesignNationwide, retrospective, population-based cohort study.Setting and participantsThis study included adult patients who had experienced pOHCA and those who had not (non-pOHCA patients) in South Korea from January 2008 to December 2018.Outcome measuresThe primary outcome was survival to discharge, and the secondary outcome was a good neurological outcome.MethodsThe basic characteristics of pOHCA and non-pOHCA patients were analysed by descriptive analysis. Logistic regression analysis was conducted for related variables, including pOHCA.ResultsA total of 173 190 patients were included, and 3582 patients (2.1%) were in the pOHCA group. Some of the pOHCA patients were young (58.2±17.8 vs 69.0±15.5, p<0.001), a few of their cardiac arrests were witnessed (12.8% vs 45.1%, p<0.001), a few were resuscitated by bystanders (8.2% vs 14.8%, p<0.001) and they had low shockable rhythm rates (1.2% vs 8.8%, p<0.001). They showed significantly lower survival to discharge and poorer neurological outcomes than non-pOHCA patients (survival to discharge, 3.7% vs 6.2%, p<0.001; good neurological outcomes, 1.3% vs 3.2%, p<0.001). There were no significant differences between pOHCA and non-pOHCA patients in terms of the adjusted ORs for survival to discharge (adjusted OR 0.608; 95% CI 0.86 to 1.27) and good neurological outcomes (adjusted OR 1.03; 95% CI 0.73 to 1.42).ConclusionThis study shows that apparent aetiology of OHCA caused by poison, did not influence survival to discharge and good neurological outcomes. Furthermore, pOHCA occurs in younger patients and has fewer witnesses and shockable rhythms. pOHCA did not influence survival to discharge and good neurological outcomes. Also, pesticides and gases were the most frequent substances causing pOHCA in South Korea.

Trends in drug poisoning hospitalizations over ten years in South Korea: mortality and length of hospital stay

“…However, the sale and distribution of these highly toxic pesticides were completely prohibited by 2012 [15,16]. This regulation not only restricted the general public's access to pesticides but also significantly reduced the number of poisonings caused by pesticides [3]. Studies have reported a decline in poisoningrelated fatalities in other nations caused by similar restrictions on toxic substances [17].…”

“…Land et al [19] (2021) focused on adult opioid poisonings in the United States and revealed a decline in overall opioid poisonings but an alarming increase in illicit opioid poisonings since 2010, indicating shifting dynamics in substance abuse [19]. Patients in South Korea differ because of the low frequency of deaths due to opioids [3], as confirmed by the recent trends. Additionally, Hernández-Calle et al [20] (2022) in Spain revealed increasing trends in both accidental and intentional drug poisonings among older adults [20], congruent with this observation of the heightened vulnerability of older adults in South Korea.…”

“…Toxic drugs were categorized into five main classifications, each of which was further subdivided into particular subcategories based on previous research [3,13]. Group 1 consisted of a variety of pharmaceuticals, including non-opioid analgesics, antipyretics, anti-epileptic agents, sedatives, hypnotics and drugs for Parkinson's disease psychotropics, narcotics, hallucinogens, autonomic nervous system medications, and other unspecified medical substances.…”

“…Drug poisoning has emerged as a significant public health concern in many countries, including South Korea, over the past few decades [1][2][3]. Various factors, ranging from accidental overdoses to intentional self-harm, cause drug poisoning.…”

“…The face of drug poisoning in South Korea has been evolving, particularly with the constant medical advancement interaction, substance availability and societal challenges. Pesticides, which are notorious for their high toxicity, were a previously major concern [3,7,8]. Their abuse caused an alarmingly high mortality rate.…”