| Cardiac arrests associated with hyperkalemia during red blood cell transfusion: a case series. | |
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MedLine Citation:
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PMID: 18349174 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Transfusion-associated hyperkalemic cardiac arrest is a serious complication of rapid red blood cell (RBC) administration. We examined the clinical scenarios and outcomes of patients who developed hyperkalemia and cardiac arrest during rapid RBC transfusion. METHODS: We retrospectively reviewed the Mayo Clinic Anesthesia Database between November 1, 1988, and December 31, 2006, for all patients who developed intraoperative transfusion-associated hyperkalemic cardiac arrest. RESULTS: We identified 16 patients with transfusion-associated hyperkalemic cardiac arrest, 11 adult and 5 pediatric. The majority of patients underwent three types of surgery: cancer, major vascular, and trauma. The mean serum potassium concentration measured during cardiac arrest was 7.2 +/- 1.4 mEq/L (range, 5.9-9.2 mEq/L). The number of RBC units administered before cardiac arrest ranged between 1 (in a 2.7 kg neonate) and 54. Nearly all patients were acidotic, hyperglycemic, hypocalcemic, and hypothermic at the time of arrest. Fourteen (87.5%) patients received RBC via central venous access. Commercial rapid infusion devices (pumps) were used in 8 of 11 (72.7%) of the adult patients, but RBC units were rapidly administered (pressure bags, syringe pumped) in all remaining patients. Mean resuscitation duration was 32 min (range, 2-127 min). The in-hospital survival rate was 12.5%. CONCLUSION: The pathogenesis of transfusion-associated hyperkalemic cardiac arrest is multifactorial and potassium increase from RBC administration is complicated by low cardiac output, acidosis, hyperglycemia, hypocalcemia, and hypothermia. Large transfusion of banked RBCs and conditions associated with massive hemorrhage should raise awareness of the potential for hyperkalemia and trigger preventative measures. |
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Authors:
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Hugh M Smith; Stacy J Farrow; Joel D Ackerman; James R Stubbs; Juraj Sprung |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Anesthesia and analgesia Volume: 106 ISSN: 1526-7598 ISO Abbreviation: Anesth. Analg. Publication Date: 2008 Apr |
Date Detail:
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Created Date: 2008-03-19 Completed Date: 2008-04-25 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 1310650 Medline TA: Anesth Analg Country: United States |
Other Details:
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Languages: eng Pagination: 1062-9, table of contents Citation Subset: AIM; IM |
Affiliation:
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Department of Anesthesiology, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Child Electrocardiography Erythrocyte Transfusion / adverse effects*, methods Heart Arrest / etiology*, mortality Humans Hyperkalemia / complications, etiology* Intraoperative Complications / therapy* Potassium / blood Retrospective Studies Surgical Procedures, Operative / classification Survival Analysis Survivors |
| Chemical | |
Reg. No./Substance:
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7440-09-7/Potassium |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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