{
    "abstract": "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.\nWe 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.\nOf 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.\nIn 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.",
    "authors": [
        {
            "affiliation": "CHU de Qu\u00e9bec Research Center CHU de Qu\u00e9bec - Universit\u00e9 Laval, Quebec City, QC, Canada.\nDepartment of Medicine, Division of Nephrology, Universit\u00e9 Laval, Quebec City, QC, Canada.\nDepartment of Anesthesiology and Critical Care Medicine, Universit\u00e9 Laval, Quebec City, QC, Canada.",
            "firstname": "Jessie",
            "initials": "J",
            "lastname": "Beaulieu"
        },
        {
            "affiliation": "CHU de Qu\u00e9bec Research Center CHU de Qu\u00e9bec - Universit\u00e9 Laval, Quebec City, QC, Canada.\nDepartment of Anesthesiology and Critical Care Medicine, Universit\u00e9 Laval, Quebec City, QC, Canada.\nCentre antipoison du Qu\u00e9bec, Quebec City, QC, Canada.\nDepartment of Family Medicine and Emergency Medicine, Universit\u00e9 Laval, Quebec City, QC, Canada.",
            "firstname": "Maude",
            "initials": "M",
            "lastname": "St-Onge"
        }
    ],
    "conclusions": "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.",
    "copyrights": "\u00a9 2024 The Authors.",
    "doi": "10.1016/j.resplu.2024.100690\n10.3109/15563650.2014.943907\n10.1080/15563650.2021.1989785\n10.1111/bcp.12814\n10.3109/15563650.2015.1118488\n10.1002/14651858.CD005490.pub2\n10.1016/s0140-6736(03)13581-7\n10.1016/0167-5273(94)02212-2\n10.1002/j.1875-9114.1984.tb03343.x\n10.1038/clpt.1985.55\n10.1007/s12012-021-09673-y\n10.3109/15563657308990513\n10.1056/nejm197604082941501\n10.1016/j.resuscitation.2015.07.017\n10.7326/0003-4819-156-1-201201030-00006\n10.1016/j.jelectrocard.2018.01.011\n10.1378/chest.110.5.1282\n10.1007/s00392-005-0293-3\n10.1016/j.hrthm.2014.03.050\n10.1016/j.jemermed.2020.07.026\n10.1016/j.repc.2016.04.016\n10.1016/j.jen.2008.06.008\n10.5543/tkda.2012.01703\n10.1016/s0003-3928(01)00033-6\n10.1016/j.toxicon.2009.06.034\n10.3109/15563650903544132\n10.1016/j.jelectrocard.2020.01.002\n10.1007/s12012-012-9171-1\n10.1177/1078155218801055\n10.5543/tkda.2015.65848\n10.2165/00044011-200727070-00008\n10.1136/bcr-2016-216995\n10.1016/j.forsciint.2008.05.002\n10.1016/j.jemermed.2018.05.021\n10.1080/15563650.2017.1317350\n10.1161/01.cir.81.6.1744\n10.1111/1742-6723.12873\n10.1097/MEJ.0b013e3283207fce\n10.1080/15563650.2018.1546010\n10.1097/CCM.0b013e31818b341c\n10.4103/0019-5359.125879\n10.1056/NEJM198211253072201\n10.3109/15563658508990641\n10.2147/TCRM.S272863\n10.4103/0975-3583.59982\n10.1111/sdi.12251\n10.1016/s0140-6736(00)90014-x\n10.1016/s0041-0101(98)00224-4\n10.1016/s0009-8981(01)00499-5\n10.1111/j.1540-8159.1986.tb06634.x\n10.1001/jama.1936.02770140013004\n10.1016/j.jemermed.2008.09.027",
    "journal": "Resuscitation plus",
    "keywords": [
        "Cardiac arrest",
        "Cardiac glycoside intoxication",
        "Digoxin intoxication",
        "Resuscitation"
    ],
    "methods": null,
    "publication_date": "2024-07-15",
    "pubmed_id": "39006132\n25089630\n34890263\n26505271\n26795743\n17054261\n12801736\n7744534\n6739314\n3978996\n34259994\n4715199\n943040\n26477412\n22213493\n6779736\n4608268\n4532575\n29477502\n9667338\n28112707\n3976124\n3739069\n8915235\n10911530\n16382383\n24685893\n13574588\n1994674\n9688359\n4714468\n3415742\n32917446\n14086416\n28159430\n6651078\n2921838\n15732447\n6742564\n16050845\n15674736\n1087816\n7273675\n13711718\n4739453\n6834696\n3523053\n18804734\n7837314\n22710590\n12555587\n14464062\n11207409\n6409318\n19591858\n20136482\n876940\n3986060\n31931467\n22618329\n3663292\n30259783\n4104698\n26536992\n936602\n17563131\n6529463\n27908913\n18602779\n29941374\n2429280\n28463019\n7110822\n2188752\n29316267\n5640895\n19262393\n862379\n7082511\n30585517\n18824911\n24469562\n1308027\n21068223\n6752715\n4057323\n33363378\n21188087\n795337\n24890576\n10768435\n10340832\n11408010\n2432487\n19201134",
    "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.",
    "title": "Antidote use for cardiac arrest or hemodynamic instability due to cardiac glycoside poisoning: A narrative review.",
    "xml": "<Element 'PubmedArticle' at 0x78850374e980>"
}