There has been no previous thorough toxicological examination of a cohort of patients with resuscitated sudden cardiac arrest. We aimed to determine the qualitative and quantitative drug composition in a resuscitated sudden cardiac arrest population, using forensic toxicology, with focus on prescribed, non-prescribed, and commonly abused drugs. Individuals aged 18–90 years with resuscitated sudden cardiac arrest of presumed cardiac causes were prospectively included from a single tertiary center. Data from the sudden cardiac arrest hospitalization was collected from medical reports. Drugs used during resuscitation or before the blood sampling were identified and excluded in each patient. Mass spectrometry-based toxicology was performed to determine the absence or presence of most drugs and to quantify the findings. Among 186 consecutively enrolled resuscitated sudden cardiac arrest patients (median age 62 years, 83% male), 90% had a shockable rhythm, and were primarily caused by ischemic heart disease (66%). In total, 90 different drugs (excluding metabolites) were identified, and 82% of patients had at least one drug detected (median of 2 detected drugs (IQR:1–4)) (polypharmacy). Commonly abused drugs were present in 16%, and QT-prolonging drugs were present in 12%. Polypharmacy (≥5drugs) were found in 19% of patients. Importantly, none had potentially lethal concentrations of any drugs. In resuscitated sudden cardiac arrest patients with cardiac arrest of presumed cardiac cause, routine toxicological screening provides limited extra information. However, the role of polypharmacy in sudden cardiac arrest requires further investigation. No occult overdose-related cardiac arrests were identified.

中文翻译：

---

使用质谱法对三级中心收治的心脏骤停幸存者进行毒理学分析

之前没有对心脏骤停复苏的患者进行彻底的毒理学检查。我们的目的是利用法医毒理学确定复苏的心脏骤停人群中的定性和定量药物成分，重点关注处方药、非处方药和常见滥用药物。前瞻性地纳入来自单一三级中心的 18-90 岁因推测心脏原因导致心脏骤停复苏的个体。心脏骤停住院的数据是从医疗报告中收集的。确定并排除每位患者在复苏期间或采血之前使用的药物。进行基于质谱的毒理学以确定大多数药物是否存在并量化结果。在连续纳入的 186 名心脏骤停复苏患者中（中位年龄 62 岁，83% 为男性），90% 的心律可电击，主要由缺血性心脏病引起（66%）。总共鉴定出 90 种不同的药物（不包括代谢物），82% 的患者至少检测到一种药物（2 种检测到的药物的中位数 (IQR:1-4)）（多重用药）。 16% 的人使用常见滥用药物，12% 的人使用延长 QT 的药物。 19% 的患者发现同时服用多种药物（≥5 种药物）。重要的是，没有任何药物含有潜在的致死浓度。对于因推测心脏原因导致心脏骤停而复苏的心脏骤停患者，常规毒理学筛查提供的额外信息有限。然而，多种药物治疗在心脏骤停中的作用需要进一步研究。没有发现与药物过量相关的隐匿性心脏骤停。