Cardiac arrest and drug-related cardiac toxicity in the Covid-19 era. Epidemiology, pathophysiology and management

Food Chem Toxicol. 2020 Nov:145:111742. doi: 10.1016/j.fct.2020.111742. Epub 2020 Sep 8.

Abstract

SARS-CoV-2 (Covid-19) infection has recently become a worldwide challenge with dramatic global economic and health consequences. As the pandemic is still spreading, new data concerning Covid-19 complications and related mechanisms become increasingly available. Accumulating data suggest that the incidence of cardiac arrest and its outcome are adversely affected during the Covid-19 period. This may be further exacerbated by drug-related cardiac toxicity of Covid-19 treatment regimens. Elucidating the underlying mechanisms that lead to Covid-19 associated cardiac arrest is imperative, not only in order to improve its effective management but also to maximize preventive measures. Herein we discuss available epidemiological data on cardiac arrest during the Covid-19 pandemic as well as possible associated causes and pathophysiological mechanisms and highlight gaps in evidence warranting further investigation. The risk of transmission during cardiopulmonary resuscitation (CPR) is also discussed in this review. Finally, we summarize currently recommended guidelines on CPR for Covid-19 patients including CPR in patients with cardiac arrest due to suspected drug-related cardiac toxicity in an effort to underscore the most important common points and discuss discrepancies proposed by established international societies.

Keywords: Cardiac arrest; Cardiopulmonary resuscitation; Covid-19; Covid-19 transmission; Drug toxicity; Heart complications.

Publication types

  • Review

MeSH terms

  • Arrhythmias, Cardiac / epidemiology*
  • Arrhythmias, Cardiac / etiology
  • Arrhythmias, Cardiac / physiopathology*
  • Betacoronavirus*
  • COVID-19
  • Cardiopulmonary Resuscitation / standards
  • Cardiotoxicity / epidemiology
  • Cardiotoxicity / etiology
  • Cardiotoxicity / physiopathology
  • Coronavirus Infections / complications*
  • Coronavirus Infections / drug therapy
  • Disease Transmission, Infectious / prevention & control
  • Heart Arrest / epidemiology*
  • Heart Arrest / etiology
  • Heart Arrest / physiopathology*
  • Humans
  • Pandemics
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / drug therapy
  • SARS-CoV-2