Abstract / Summary
Objective: To summarise evidence on the effectiveness of specific alterations to standard advanced life support during ongoing cardiopulmonary resuscitation in adults and children with cardiac arrest due to a presumed toxicological cause. Methods: We searched MEDLINE (OVID platform), Embase (OVID platform), and Cochrane CENTRAL from inception to 22nd July 2026 for relevant observational and interventional studies with a control group. We excluded studies focussed specifically on opioid toxicity. Two authors independently screened studies for inclusion. Our primary outcome was 30-day survival. We assessed risk of bias using the Cochrane recommended tools and certainty of evidence using the GRADE system. Results: We identified four observational studies, of which none specifically focused on children and three included fewer than 100 patients. Studies examined general toxicological causes ( n = 2), smoke inhalation and cyanide poisoning ( n = 1), and beta-blocker and calcium-channel blocker overdose ( n = 1). All studies were at critical risk of bias. Across the four studies, nine interventions were reported. Whilst some interventions were associated with either benefit or harm, estimates of effect were very imprecise and challenging to interpret. The largest study (1545 patients) reported that sodium bicarbonate use in out-of-hospital cardiac arrest due to suspected drug overdose was associated with lower survival to hospital discharge (adjusted odds ratio 0.16, 95% confidence interval 0.08–0.31). Conclusion: Current evidence does not support the modification of standard advanced life support during cardiac arrest due to a presumed toxicological cause in adults or children. Registration: PROSPERO CRD420251149412.