Introduction: In undifferentiated cardiac arrest, the “5Hs and 5Ts” approach has been the cornerstone guiding advanced care and management. In recent years, however, more streamlined and targeted approaches have been posited for specific subsets of arrests where a single H or T is likely to be the cause. Specific Hs and Ts — for example, traumatic arrest, drowning (hypoxia), and hypothermia, to name just a few — have each enjoyed tailored approaches and algorithms that inform the sequence and dictate care to focus on high-yield diagnostics and interventions that are context-specific and depart somewhat from standard ACLS algorithms. Methods: This systematic review examines the potential for developing a focused algorithm for recreational toxicologic arrests at music festivals. Results: The evidence supporting specific interventions (e.g., airway support, antidotes, deviation from standard ACLS medications) is reviewed, and the primary considerations (toxidrome, substances used, presenting rhythm, etc) affecting decision-making are summarized for the tailored management of cardiac arrest related to recreational substance use at music festivals. Conclusion: Cardiac arrests at music festivals would benefit from a tailored approach to high-yield management, medications, and interventions based on substances ingested, presenting toxidrome, and presenting cardiac rhythm. There is a need for further research on this subject to bolster the evidence for deviation from standard Advanced Cardiac Life Support (ACLS) practices, as a tailored toxicological approach would likely confer significant benefits to patient outcomes.
Munn et al. (Sun,) studied this question.