COVID-19-associated cardiac arrest

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For COVID-19 frequently asked inpatient questions, click here
For COVID-19 frequently asked outpatient questions, click here

WikiDoc Resources for COVID-19-associated cardiac arrest

Articles

Most recent articles on COVID-19-associated cardiac arrest

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Review articles on COVID-19-associated cardiac arrest

Articles on COVID-19-associated cardiac arrest in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on COVID-19-associated cardiac arrest

Images of COVID-19-associated cardiac arrest

Photos of COVID-19-associated cardiac arrest

Podcasts & MP3s on COVID-19-associated cardiac arrest

Videos on COVID-19-associated cardiac arrest

Evidence Based Medicine

Cochrane Collaboration on COVID-19-associated cardiac arrest

Bandolier on COVID-19-associated cardiac arrest

TRIP on COVID-19-associated cardiac arrest

Clinical Trials

Ongoing Trials on COVID-19-associated cardiac arrest at Clinical Trials.gov

Trial results on COVID-19-associated cardiac arrest

Clinical Trials on COVID-19-associated cardiac arrest at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on COVID-19-associated cardiac arrest

NICE Guidance on COVID-19-associated cardiac arrest

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FDA on COVID-19-associated cardiac arrest

CDC on COVID-19-associated cardiac arrest

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Patient Handouts on COVID-19-associated cardiac arrest

Directions to Hospitals Treating COVID-19-associated cardiac arrest

Risk calculators and risk factors for COVID-19-associated cardiac arrest

Healthcare Provider Resources

Symptoms of COVID-19-associated cardiac arrest

Causes & Risk Factors for COVID-19-associated cardiac arrest

Diagnostic studies for COVID-19-associated cardiac arrest

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D. Ayesha Javid, MBBS[2]

Synonyms and Keywords: Cardiac arrest, In-hospital cardiac arrest, IHCA, Out-of-hospital cardiac arrest, OHCA, Covid-19, SARS-COV-2, Ventricular arrhythmia, pulseless electrical activity, Asystole, Return Of Spontaneouse Circulation, ROSC

Overview

SARS-COV2 which causes coronavirus disease 2019 (covid-19) led to global pandemic on March 11, 2020, is an enveloped B-coronavirus transmitted via respiratory droplets, attached via viral spike protein to angiotensin-converting enzyme 2 receptor (ACE2 receptor) causing clinical asyndrome of coronavirus disease 2019. Severe covid-19 may progress to develope acute respiratory distress syndrome, cardiovascular complications, shock, and death. Cardiac arrest is often unexpected and acute event may present in every hospitalized patient. Abnormal vital signs can be the predictos of in-hospital cardiac arrest. During the outbreak of covid-19, there were increase reports of in-hospital cardiac arrest (IHCA), out-of hospital cardiac arrest (OHCA), lower rate of successful cardiopulmonary resuscitation (CPR), and increased mortality. 30-days mortality in covid-19 patients was increased 3.4 fold in OHCA and 2.3 fold in IHCA compared with pre-pandemic period. survival of in-hospital cardiac arrest was poor. Factors related to restricted or delay access to emergency care, late presentation of ACS or heart failure in hospital, avoidance of witness CPR in public due to fear contracting covid-19, as well as the side effects of drugs and thrombotic complications related to covid-19 led to higher incidence of cardiac arrest during covid-19 pandemic.

Historical Perspective

  • In December 2019, the COVID-19 outbreak first appeared in China, Wuhan.[1]
  • In January 2020, the first COVID-19 case was documented in the United States.[2]
  • On February 20, 2020, the first case of COVID-19 was documented in the Province of Lodi in Italy.[3]
  • In April 2020, an increase of out-of-hospital cardiac arrest was reported during the COVID-19 pandemic in Italy by Dr.Enrico Baldi.[4]

Classification

Cardiac arrest associated with COVID-19 may be classified into three subtypes:[5]

Causes

The potential causes of ventricular tachyarrhythmia and sudden cardiac death in COVID-19 include:[6]

Pathophysiology

Differentiating inherited cardiac arrest from other causes of cardiac arrest

  • To view the differential diagnosis of COVID-19-associated cardiac arrest click here.
  • To view the differential diagnosis of COVID-19 click here.

Epidemiology and Demographics

Incidence

Mortality

Age

Gender

Race

Risk Factors

Screening

Natural History, Complications, and Prognosis

Diagnosis

Diagnostic Criteria

  • The diagnosis of sudden cardiac death is made when the following diagnostic criteria are met:
  • Prodromes phase occurring weeks or months before an event includes: new or worsening cardiovascular symptoms(chest pain, dyspnea, palpitations, fatigability)
  • Onset of terminal event occurring one hour before cardiac arrest includes: abrupt change in clinical status(arrhythmia, hypotension, chest pain, dyspnea, lightheadness)
  • Cardiac arrest includes: sudden collapse, loss of effective circulation, loss of consciousness
  • Biologic death: failure of resuscitation or failure of electrical, mechanical, or CNS function after initial resuscitation

Symptoms

Physical Examination

There is no specific finding associated with physical examination with cardiac arrest in COVID-19.

Laboratory Findings

  • An elevated concentration of serum cardiac troponinI was detected in severe COVID-19 patients with cardiac complications. [19]

Imaging Findings

There are no imaging study findings associated with cardiac arrest in COVID-19.

Electrocardiogram


Treatment

  • The mainstay of therapy for COVID-19-related cardiac arrest is cardiopulmonary resuscitation with attention to the following points:[20]
    • Wearing personal protective equipment (PPE) before entering the room or on the scene.
    • Limiting the personnel in the room or on the scene
    • Using high-efficacy particulate air filter for ventilator
    • Intubating with a cuffed tube
    • Stopping chest compression for intubation
    • Using bag-mask device before intubation
    • Using non-rebreathing face mask instead of bag-mask for short term oxygenation

Prevention

Effective measures for the primary prevention of ventricular arrhythmia during using hydroxychloroquine in the setting of long QT syndrome or aquired LQTS or heart rate <50/min or receiving azithromycin, remdesivir, lopinavir, ritonavir, include EKG and QTc measurement.[14]

References

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  2. Sayre, Michael R.; Barnard, Leslie M.; Counts, Catherine R.; Drucker, Christopher J.; Kudenchuk, Peter J.; Rea, Thomas D.; Eisenberg, Mickey S. (2020). "Prevalence of COVID-19 in Out-of-Hospital Cardiac Arrest: Implications for Bystander CPR". Circulation. doi:10.1161/CIRCULATIONAHA.120.048951. ISSN 0009-7322.
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  13. Giudicessi JR, Roden DM, Wilde AAM, Ackerman MJ (2020). "Genetic susceptibility for COVID-19-associated sudden cardiac death in African Americans". Heart Rhythm. doi:10.1016/j.hrthm.2020.04.045. PMC 7198426 Check |pmc= value (help). PMID 32380288 PMID: 32380288 Check |pmid= value (help).
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  20. Edelson, Dana P.; Sasson, Comilla; Chan, Paul S.; Atkins, Dianne L.; Aziz, Khalid; Becker, Lance B.; Berg, Robert A.; Bradley, Steven M.; Brooks, Steven C.; Cheng, Adam; Escobedo, Marilyn; Flores, Gustavo E.; Girotra, Saket; Hsu, Antony; Kamath-Rayne, Beena D.; Lee, Henry C.; Lehotsky, Rebecca E.; Mancini, Mary E.; Merchant, Raina M.; Nadkarni, Vinay M.; Panchal, Ashish R.; Peberdy, Mary Ann R.; Raymond, Tia T.; Walsh, Brian; Wang, David S.; Zelop, Carolyn M.; Topjian, Alexis A.; Starks, Monique Anderson; Bobrow, Bentley J.; Chan, Melissa; Berg, Katherine; Duff, Jonathan P.; Joyner, Benny L.; Lasa, Javier J.; Levy, Arielle; Mahgoub, Melissa; O’Connor, Michael F.; Hoover, Amber V.; Rodriguez, Amber J.; Meckler, Garth; Roberts, Kathryn; Mohr, Nicholas M.; Nassar, Boulos; Rubinson, Lewis; Sutton, Robert M.; Schexnayder, Stephen M.; Kleinman, Monica; de Caen, Allan; Morgan, Ryan; Bhanji, Farhan; Fuchs, Susan; Terry, Mark; McBride, Mary; Levy, Michael; Cabanas, Jose G.; Tan, David K.; Moitra, Vivek K.; Szokol, Joseph W. (2020). "Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19". Circulation. 141 (25). doi:10.1161/CIRCULATIONAHA.120.047463. ISSN 0009-7322.


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