Validation of the Prognostic Utility of the Electrocardiogram for Acute Drug Overdose

Manini, Alex F.; Nair, Ajith; Vedanthan, Rajesh; Vlahov, David; Hoffman, Robert S.

doi:10.1161/jaha.116.004320

Cited by 30 publications

(9 citation statements)

References 33 publications

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“…A report con rmed that QTc can be used as a predictor of the adverse outcomes in acute poisoning [24]. Likewise, another study demonstrated that ECG can be used as an indicator of cardiovascular prognosis in patients with acute drug poisoning [25]. These ndings were in agreement with our study results, which were applicable to a broader population than the aforementioned studies.…”

Section: Discussionsupporting

confidence: 92%

Early Predictive Value of the Electrocardiogram Combined with Q-SOFA Score for the Prognosis of Acute Poisoning Patients: A Retrospective Analysis

Yin

et al. 2022

Preprint

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Background: Acute poisoning is a worldwide and frequently occurring disease, endangering millions of people and leading to ten thousands of deaths every year. Early effective evaluation and appropriate treatment are the key to improve the clinical outcomes. However, early accurate assessment of the conditions in patients with acute poisoning is challenging. This study aimed to investigate the utility of electrocardiogram (ECG) combined with quick Sequential Organ Failure Assessment (q-SOFA) score as early prognostic predictors in acute poisoning patients. Methods: The clinical data of acute poisoning patients were collected from 2016 to 2022 in a regional medical center. The statistical analysis was used to evaluate the risk factors related to prognosis based on their ECG. And the receiver operating characteristic (ROC) curve were used to evaluate the early diagnostic value of ECG combined with q-SOFA. Results: Among the 572 patients, 119 patients belonged to the survived group and 453 patients belonged to the died. ECG abnormalities were detected in 71.3% of survivors and 88.2% of dead (p＜0.05). One variable analysis revealed that heart rate (HR), ECG axis, PR intervals, RV5, R+S, and ST-T change (all p＜0.05) of ECG had significant differences in the prognosis of patients between two groups. Multifactorial logistic results showed that HR (OR=1.035, 95%CI 1.026~1.044) and QTc (OR=1.013, 95%CI 1.007~1.019) were independent risk factors for death. ROC curve analysis revealed that the area under the cure (AUC) of ECG was 0.777 (95%CI 0.728~0.827), q-SOFA score was 0.736 (95%CI 0.684~0.787), PSS score was 0.617 (95%CI 0.558~0.677), and the prediction model constructed based on HR, QTc and q-SOFA score was 0.808 (95%CI 0.763~0.852), with the best diagnostic accuracy (50.4%). Conclusion: ECG combined with q-SOFA is a useful early predictor of poor outcome in acute poisoning patients. It has better accuracy and certain feasibility compared with PSS score.

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Section: Discussionsupporting

confidence: 92%

Early Predictive Value of the Electrocardiogram Combined with Q-SOFA Score for the Prognosis of Acute Poisoning Patients: A Retrospective Analysis

Yin

et al. 2022

Preprint

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“…Rationale The indication for admission to a critical care unit (ICU, CCU, or even an expert centre) is based on clinical (toxidromes) and ECG signs, but also on the toxic potential related to the nature of the involved toxin, the reported ingested dose and time of exposure, as well as the patient's clinical background [14][15][16]. The most common toxins requiring ICU admission are cardiovascular drugs, almost systematically, and psychotropic drugs associated with a risk of serious complications such as tricyclic antidepressants or antipsychotics [17][18][19].…”

Section: Recommendation In the Form Of An Expert Opinion/strong Consementioning

confidence: 99%

Management of pharmaceutical and recreational drug poisoning

Mégarbane

Oberlin

Alvarez

et al. 2020

Ann. Intensive Care

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Background Poisoning is one of the leading causes of admission to the emergency department and intensive care unit. A large number of epidemiological changes have occurred over the last years such as the exponential growth of new synthetic psychoactive substances. Major progress has also been made in analytical screening and assays, enabling the clinicians to rapidly obtain a definite diagnosis. Methods A committee composed of 30 experts from five scientific societies, the Société de Réanimation de Langue Française (SRLF), the Société Française de Médecine d’Urgence (SFMU), the Société de Toxicologie Clinique (STC), the Société Française de Toxicologie Analytique (SFTA) and the Groupe Francophone de Réanimation et d’Urgences Pédiatriques (GFRUP) evaluated eight fields: (1) severity assessment and initial triage; (2) diagnostic approach and role of toxicological analyses; (3) supportive care; (4) decontamination; (5) elimination enhancement; (6) place of antidotes; (7) specificities related to recreational drug poisoning; and (8) characteristics of cardiotoxicant poisoning. Population, Intervention, Comparison, and Outcome (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Analysis of the literature and formulation of recommendations were then conducted according to the GRADE® methodology. Results The SRLF-SFMU guideline panel provided 41 statements concerning the management of pharmaceutical and recreational drug poisoning. Ethanol and chemical poisoning were excluded from the scope of these recommendations. After two rounds of discussion and various amendments, a strong consensus was reached for all recommendations. Six of these recommendations had a high level of evidence (GRADE 1±) and six had a low level of evidence (GRADE 2±). Twenty-nine recommendations were in the form of expert opinion recommendations due to the low evidences in the literature. Conclusions The experts reached a substantial consensus for several strong recommendations for optimal management of pharmaceutical and recreational drug poisoning, mainly regarding the conditions and effectiveness of naloxone and N-acetylcystein as antidotes to treat opioid and acetaminophen poisoning, respectively.

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“…The observed QTc prolongation is in agreement with case reports of subjects admitted to emergency departments after ibogaine ingestion. A QTc of > 500 ms is associated with a large increase [odds ratio (OR) = 11.2, 95% confidence interval (CI) = 4.6–27] in the risk of an adverse cardiovascular disorder in patients presenting with a drug overdose to the emergency room (ER) [ 45 ]. The patients in these case reports showed a prolonged QTc, together with ventricular fibrillation, TdP or both [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Safety of ibogaine administration in detoxification of opioid‐dependent individuals: a descriptive open‐label observational study

et al. 2021

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Background and aimsIbogaine is an indole alkaloid used in rituals of the African Bwiti tribe. It is also used in non-medical settings to treat addiction. However, ibogaine has been linked to several deaths, mainly due to cardiac events called torsades des pointes preceded by QTc prolongation as well as other safety concerns. This study aimed to evaluate the cardiac, cerebellar and psychomimetic safety of ibogaine in patients with opioid use disorder. Design A descriptive open-label observational study. Setting Department of psychiatry in a university medical center, the Netherlands. Participants Patients with opioid use disorder (n = 14) on opioid maintenance treatment with a lasting wish for abstinence, who failed to reach abstinence with standard care. Intervention and measurements After conversion to morphine-sulphate, a single dose of ibogaine-HCl 10 mg/kg was administered and patients were monitored at regular intervals for at least 24 hours assessing QTc, blood pressure and heart rate, scale for the assessment and rating of ataxia (SARA) to assess cerebellar side effects and the delirium observation scale (DOS) to assess psychomimetic effects. FindingsThe maximum QTc (Fridericia) prolongation was on average 95ms (range 29-146ms). Fifty percent of subjects reached a QTc of over 500ms during the observation period. In six out 14 subjects prolongation above 450ms lasted beyond 24 hours after ingestion of ibogaine. No torsades des pointes were observed. Severe transient ataxia with inability to walk without support was seen in all patients. Withdrawal and psychomimetic effects were mostly well-tolerated and manageable (11/14 did not return to morphine within 24 hours, DOS scores remained below threshold). ConclusionsThis open-label observational study found that ibogaine treatment of patients with opioid use disorder can induce a clinically relevant but reversible QTc prolongation, bradycardia, and severe ataxia.

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Validation of the Prognostic Utility of the Electrocardiogram for Acute Drug Overdose

Cited by 30 publications

References 33 publications

Early Predictive Value of the Electrocardiogram Combined with Q-SOFA Score for the Prognosis of Acute Poisoning Patients: A Retrospective Analysis

Early Predictive Value of the Electrocardiogram Combined with Q-SOFA Score for the Prognosis of Acute Poisoning Patients: A Retrospective Analysis

Management of pharmaceutical and recreational drug poisoning

Safety of ibogaine administration in detoxification of opioid‐dependent individuals: a descriptive open‐label observational study

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