This systematic review assessed modifications to advanced life support during presumed toxicological cardiac arrest, excluding studies focused specifically on opioid toxicity. Four observational studies examined nine interventions; none specifically focused on children, and three enrolled fewer than 100 patients. The primary outcome was 30-day survival. In the largest study (1,545 patients), sodium bicarbonate use during out-of-hospital arrest following suspected drug overdose was associated with lower survival to hospital discharge (adjusted odds ratio 0.16, 95% confidence interval 0.08–0.31). All studies had critical risk of bias, and intervention effect estimates were generally very imprecise.
Evidence for toxicology-specific modifications during cardiac arrest remains highly uncertain. The sodium bicarbonate finding is observational and does not establish that bicarbonate caused lower survival.
Study limitation: Only four observational studies were available, all at critical risk of bias; none specifically focused on children.
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