US Hospital Data About Neonatal Abstinence Syndrome and Maternal Opioid-Related Diagnoses

Abstract

In a rodent model using a 12-minute duration of cardiac arrest, a single dose of sodium nitrite administered a few minutes after the start of resuscitation was associated with a 48% reduction in mortality. 2 Even though these results served as a compelling rationale for a clinical trial, our study showed that in a high-functioning emergency medical services system optimized for cardiac arrest management, there was no survival benefit in patients with out-of-hospital cardiac who received sodium nitrite. We doubt that the timing of nitrite delivery alone explains this lack of benefit because there were no significant differences between the randomization groups with regard to hospital outcomes (admitted to hospital or survival to discharge) when comparing patients in the lowest 25th percentile of time to drug administration from call (<14.6 minutes) vs patients in the highest 25th percentile (>21.6 minutes). These times to drug administration likely represent a limitation in terms of drug delivery for patients treated for out-of-hospital cardiac arrest and demonstrate that the time frames used in animal studies are not possible in clinical trials involving humans who experience out-of-hospital cardiac arrest.Important predictors of outcomes following out-ofhospital cardiac arrest include patient age, witnessed arrest, and paramedic response time. However, in our study, differences in the likelihood of survival to hospital admission between placebo and both doses of sodium nitrite were minimal after adjusting for age, sex, public location of cardiac arrest, witnessed initial rhythm, and time from call to survival. Planned and post hoc subgroup analyses also did not demonstrate a significant effect on our primary end point. It is therefore very unlikely that additional analyses will demonstrate a benefit with sodium nitrite for survival of out-of-hospital cardiac arrest.The suggestion by Sang and Xu to consider sodium nitrite for treatment of patients with in-hospital cardiac arrest (who typically receive advanced cardiovascular life support within 5-10 minutes 3 ) is an interesting idea. However, the etiologies and outcomes of in-hospital cardiac arrest differ from out-ofhospital cardiac arrest. Therefore, the use of sodium nitrite for in-hospital cardiac arrest remains an unanswered question.