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.

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

Fig. 1

Cardiac and non-cardiac causes of cardiac arrest in Covid-19 infection. ARDS, acute respiratory distress syndrome; VTE, venous thromboembolism; DIC, disseminated intravascular coagulation. Certain items on this figure have been adapted from Servier Medical Art by Servier (https://smart.servier.com – licensed under Creative Commons Attribution 3.0 Unported License).