Evidence map›Paper›PMID 41062055›Full record

ArticleResuscitation2025

Validation of the naloxone cardiac arrest decision instrument for identifying opioid-associated cardiac arrests.

David G Dillon, Katherine S Allan, Juan Carlos C Montoy, Mika'il Visanji, Robert M Rodriguez, Steve Lin, Ralph C Wang

Abstract readValidation Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Resuscitation, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

David G DillonDepartment of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, CA, USA. Electronic address: djdillon@ucdavis.edu.
Katherine S AllanDivision of Cardiology and Li Ka Shing Knowledge Institute (LKSKI), Unity Health Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Juan Carlos C MontoyDepartment of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA.
Mika'il VisanjiMcMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada.
Robert M RodriguezDepartment of Medicine, University of California Riverside School of Medicine.
Steve LinInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Emergency Medicine and Li Ka Shing Knowledge Institute (LKSKI), Unity Health Toronto, Toronto, Ontario, Canada.
Ralph C WangDepartment of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA.

Funding

Improving the Identification of Opioid-Associated Out-of-Hospital Cardiac ArrestK38HL165363 · NHLBI · UNIVERSITY OF CALIFORNIA AT DAVIS · PI DILLON, DAVID G · 2023 to 2024
$212k
NHLBI NIH HHS K38 HL165363
6 · The paper itself

Abstract

backgroundUp to fifteen percent of out-of-hospital cardiac arrests (OHCAs) are precipitated by occult drug overdose - cases without history or evidence of drug use that are often attributed to a non-overdose cause. The NAloxone Cardiac ARrest Decision Instrument (NACARDI) was derived to help emergency medical service (EMS) providers rapidly identify patients at higher risk of occult opioid-associated (OA)-OHCAs during resuscitation. In this analysis we externally validate NACARDI in an independent cohort of OHCA patients.

methodsWe conducted a retrospective validation using data from EMS-attended OHCA patients and coroner records in Ontario, Canada between 2020-2021. Inclusion criteria were age ≥18 years and OHCA death with a coroner record. Exclusion criteria were EMS-suspected drug overdose or known cause of the OHCA. NACARDI consists of two criteria: patient age and unwitnessed cardiac arrest. Two cut-offs for patient age were assessed for this validation: <50 years (NACARDI-50) and <60 years (NACARDI-60). The primary outcome was coroner adjudicated cause of death. We calculated screening characteristics and receiver operating characteristic (ROC) curves using standard formulae.

resultsOf 2904 OHCA cases without an obvious cause, 791 had coroner evaluations and 121 (15.3 %) were adjudicated as occult OA-OHCA. NACARDI-60 had: sensitivity 82.6 % (95 %CI 74.9-88.4 %), specificity 77.1 % (95 %CI 73.8-80.1 %), negative predictive value 96.1 % (95 %CI 94.1-97.4 %), and positive predictive value 39.4 % (95 %CI 33.6-45.5 %). NACARDI-50 had: sensitivity 63.6 % (95 %CI 54.4-72.2 %), specificity 89.3 % (95 %CI 86.7-91.5 %), negative predictive value 93.2 % (95 %CI 90.9-95.0 %), and positive predictive value 51.7 % (95 %CI 43.4-59.9 %). ROC curves for both NACARDI-50 and NACARDI-60 demonstrated excellent discrimination for occult OA-OHCA.

conclusionIn this external validation cohort, NACARDI had a sensitivity and specificity sufficiently high to aid in the real-time identification of occult OA-OHCA in the field. NACARDI has the potential to guide targeted interventions for OA-OHCA.

Indexed as

Analgesics, OpioidNaloxoneNarcotic AntagonistsOpiate OverdoseOut-of-Hospital Cardiac ArrestAdultAgedCardiopulmonary ResuscitationDecision Support TechniquesEmergency Medical ServicesFemaleHumansMaleMiddle AgedOntarioRetrospective StudiesAnalgesics, OpioidNaloxoneNarcotic AntagonistsCardiac arrestEmergency medicineOpioid overdoseOut-of-hospital cardiac arrestPharmacotherapy

Identifiers

PMID41062055
PMCPMC12716235

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.