Characteristics, Interventions, and Deprivation Patterns in Suspected Opioid-Associated Out-of-Hospital Cardiac Arrests Attended by North East Ambulance Service NHS Foundation Trust: A 36-Month Service Evaluation

Background: Drug-poisoning deaths in England and Wales have more than doubled since 2012, with the North East of England persistently reporting the highest mortality rates. Opioid-associated out-of-hospital cardiac arrest (OA-OHCA) presents distinct clinical and operational challenges for ambulance services, particularly amid the emergence of potent synthetic opioids and uncertainty over the role of naloxone during cardiac arrest. This service evaluation sought to characterise the incidence, clinical features, and deprivation patterns of suspected OA-OHCA attended by North East Ambulance Service NHS Foundation Trust (NEAS), and to describe their geographic distribution. Methods: A retrospective service evaluation was conducted using structured and reported fields from the NEAS electronic patient care record (ePCR) system between 1 January 2022 and 31 December 2024. Inclusion required a documented cardiac resuscitation together with either a reported aetiology of drug overdose, or documented naloxone administration. Data were analysed descriptively. Results: 351 cases met the inclusion criteria. The mean age was 42.9 years; 69.2% were male. Cases represented a rising proportion of OHCA where resuscitation was attempted by NEAS across the period (4.7% in 2022 to 5.9% in 2024). Naloxone was administered in 87.2% of incidents, adrenaline in 86.9%, and amiodarone in 9.4%. Advanced airway management was recorded in 88.3% and intraosseous access in 75.5%; defibrillation was performed in 16.5%. Cases were concentrated in the most deprived communities, with Index of Multiple Deprivation (IMD) deciles 1-3 comprising 71.8% of the cohort. Conclusion: Suspected drug-related cardiac arrests in the NEAS region predominantly affected working-age adults in deprived communities, and were managed with consistent airway, ventilation, vascular access, and naloxone administration alongside infrequent defibrillation, consistent with a predominantly asphyxial arrest model. This evaluation provides a descriptive baseline that could inform service planning and provides the empirical foundation for a subsequent qualitative study of paramedic clinical decision-making in OA-OHCA.