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Review
. 2024 Jun 21:19:100690.
doi: 10.1016/j.resplu.2024.100690. eCollection 2024 Sep.

Antidote use for cardiac arrest or hemodynamic instability due to cardiac glycoside poisoning: A narrative review

Jessie Beaulieu  1   2   3 , Maude St-Onge  1   3   4   5
Affiliations
Review

Antidote use for cardiac arrest or hemodynamic instability due to cardiac glycoside poisoning: A narrative review

Jessie Beaulieu et al. Resusc Plus. .

Abstract

Introduction: Cardiac glycosides comprise medications such as digoxin and digitoxin, plants, and even certain toad venoms. Intoxication with cardiac glycosides can lead to hemodynamic instability and cardiac arrest. With this narrative review, our objective was to determine if any therapy used in a near-cardiac arrest state due to cardiac glycoside poisoning could improve survival with favourable functional and neurological outcomes.

Methods: We searched the Medline, PubMed, EMBASE and Cochrane Library databases up to February 2022 for controlled trials, observational studies, and case reports. We reviewed studies if participants were exposed to a cardiac glycoside, had hemodynamic instability, and an intervention was attempted to reverse the toxicity. The effect of interventions on (1) survival with favourable functional and neurological outcomes and (2) correction of hemodynamic instability was assessed.

Results: Of the 2422 studies found, 73 were included for analysis, of which 58 were case reports or series, and 15 were observational cohorts. Most patients were intoxicated with medication (60 individual cases and 11 observational cohorts). Administration of digoxin immune-Fab fragments was associated with improved hemodynamic status and survival in medication patients. Administration of magnesium, cardioversion, and cardiac pacing was associated with favourable outcomes, while administration of atropine, antiarrhythmics, or calcium was not.

Conclusion: In patients with hemodynamic instability due to cardiac glycoside intoxication, digoxin immune-Fab fragments should be given, and magnesium administration, cardioversion, and cardiac pacing can reasonably be attempted.

Keywords: Cardiac arrest; Cardiac glycoside intoxication; Digoxin intoxication; Resuscitation.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [This work was done in parallel of the development of the 2023 guidelines of the American Heart Association.].

Figures

Fig. 1
Fig. 1
PRISMA flowchart. Made with CMap Tools.
Fig. 2
Fig. 2
Proportion of surviving cases, categorized by population and intervention. Made with Powerpoint.
Fig. 3
Fig. 3
Proportion of cases showing hemodynamic improvement, categorized by population and intervention. Made with Powerpoint.
See this image and copyright information in PMC

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