SUDDEN CARDIAC DEATH AND SUBSTANCE-ABUSE

There has been a steady increase in the number of deaths occurring from volatile substance abuse per year. The majority of deaths are in males, the peak age group being 15-19 years. Fuel gases i.e. cigarette lighter refills (butane), propane and gasoline and other solvents such as typewriter correction fluid, dry-cleaning fluids (trichloroethane) and fire extinguishers (bromochlorodifluoro-methane) are responsible for approximately 60% of these deaths. Volatile substances sensitise the heart to circulating catecholamines, such that sudden alarm or exercise may precipitate sudden death. The main mechanism of cardiac arrest is a cardiac arrhythmia, but anoxia, respiratory depression and vagal stimulation along with aspiration of vomit or trauma may be contributing factors to the sudden death. In addition, particularly butane gas inhalation may be associated with severe laryngeal oedema and laryngospasm. Resuscitation from sudden death associated with volatile substance abuse is rare, since the majority of deaths are unwitnessed. It is suggested that cardiac arrhythmias should be treated conventionally. Sympathomimetic drugs should be avoided. Early during the resuscitation process, β-adrenergic blocking agents should be administered to protect the catecholamine-sensitised heart. Early intubation in the management of the cardiac arrest should be avoided, if the inhalational agent is known to be associated with laryngospasm. Respiratory failure should be treated supportively with correction of the hypoxaemia. As hypokalaemia and metabolic acidosis may complicate the sudden death, the early correction of these metabolic abnormalities should be attempted. © 1995.