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

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.

Study on the Effects of Optimized Emergency Nursing Combined with Mild Hypothermia Nursing on Neurological Prognosis, Hemodynamics, and Cytokines in Patients with Cardiac Arrest

“…Cardiac arrest (CA) is a common acute and critical condition in the emergency department. Ventricular fibrillation [ 1 ], cardiac tamponade [ 2 ], pulmonary embolism [ 3 ], electrolyte abnormalities [ 4 ], drug poisoning [ 5 ], and other types of causes can be triggered. At the onset of the disease, the patient's heart beat suddenly stops and the blood uptake function suddenly disappears, which can then trigger severe hypoxia and ischemia in the tissues and organs of the whole body, the release of inflammatory factors, and the production of various metabolites, resulting in multiorgan disorders or disorders in the organism, called postcardiac arrest syndrome (PCAS) [ 6 ].…”

Hydroxychloroquine Attenuates hERG Channel by Promoting the Membrane Channel Degradation: Computational Simulation and Experimental Evidence for QT-Interval Prolongation with Hydroxychloroquine Treatment

“…Drug-Induced Blockade of hERG Channel Accumulating evidence indicated that the incidence of cardiac arrest was adversely increased during the COVID-19 pandemic, possibly exacerbated by the increased risk of druginduced cardiotoxicity due to off-label use or inadequate evaluation [19]. Thus, it is necessary to systematically evaluate the potential of hERG channel blockade in drugs tested in COVID-19 clinical trials.…”

Estimation of Asthma Symptom Onset Using Internet Search Queries: Lag-Time Series Analysis

“…Recent evidence has also indicated that the COVID-19 pandemic has led patients to use internet search on Google to seek out medial information and treatment in replacement of professional medical attention [25]. For instance, compared with previous years, there have been significant reductions in hospital presentations for acute myocardial infarctions and concurrent increases in out-of-hospital cardiac arrests during the COVID-19 pandemic and a marked spike in search volume for chest pain [26,27]. Therefore, internet search queries related to respiratory symptoms may offer insight into the true incidence of respiratory illnesses during COVID-19, as fear of contracting COVID-19 may prevent patients from seeking hospital care.…”

“…Future studies should test the ability of Google searches in the hospital setting to predict cases and reduce the burden on hospitals. In addition, since the COVID-19 pandemic, it has been postulated that many patients are not seeking care for their arising symptoms because of fears of COVID-19 transmission [27]. Therefore, the use of internet search could help identify real-time and accurate onset of asthma during the time of the COVID-19 pandemic.…”