| Hypocalcemia following resuscitation from cardiac arrest revisited. | |
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MedLine Citation:
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PMID: 19913975 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Hypocalcemia associated with cardiac arrest has been reported. However, mechanistic hypotheses for the decrease in ionized calcium (iCa) vary and its importance unknown. The objective of this study was to assess the relationships of iCa, pH, base excess (BE), and lactate in two porcine cardiac arrest models, and to determine the effect of exogenous calcium administration on post-resuscitation hemodynamics. METHODS: Swine were instrumented and VF was induced either electrically (EVF, n=65) or spontaneously, ischemically induced (IVF) with balloon occlusion of the LAD (n=37). Animals were resuscitated after 7 min of VF. BE, iCa, and pH, were determined prearrest and at 15, 30, 60, 90, 120 min after ROSC. Lactate was also measured in 26 animals in the EVF group. Twelve EVF animals were randomized to receive 1g of CaCl(2) infused over 20 min after ROSC or normal saline. RESULTS: iCa, BE, and pH declined significantly over the 60 min following ROSC, regardless of VF type, with the lowest levels observed at the nadir of left ventricular stroke work post-resuscitation. Lactate was strongly correlated with BE (r=-0.89, p<0.0001) and iCa (r=-0.40, p<0.0001). In a multivariate generalized linear mixed model, iCa was 0.005 mg/dL higher for every one unit increase in BE (95% CI 0.003-0.007, p<0.0001), while controlling for type of induced VF. While there was a univariate correlation between iCa and BE, when BE was included in the regression analysis with lactate, only lactate showed a statistically significant relationship with iCa (p=0.02). Post-resuscitation CaCl(2) infusion improved post-ROSC hemodynamics when compared to saline infusion (LV stroke work control 8+/-5 gm vs 23+/-4, p=0.014, at 30 min) with no significant difference in tau between groups. CONCLUSIONS: Ionized hypocalcemia occurs following ROSC. CaCl(2) improves post-ROSC hemodynamics suggesting that hypocalcemia may play a role in early post-resuscitation myocardial dysfunction. |
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Authors:
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Scott T Youngquist; Theodore Heyming; John P Rosborough; James T Niemann |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural Date: 2009-11-13 |
Journal Detail:
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Title: Resuscitation Volume: 81 ISSN: 1873-1570 ISO Abbreviation: Resuscitation Publication Date: 2010 Jan |
Date Detail:
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Created Date: 2010-02-01 Completed Date: 2010-05-04 Revised Date: 2011-07-19 |
Medline Journal Info:
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Nlm Unique ID: 0332173 Medline TA: Resuscitation Country: Ireland |
Other Details:
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Languages: eng Pagination: 117-22 Citation Subset: IM |
Copyright Information:
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Copyright 2009 Elsevier Ireland Ltd. All rights reserved. |
Affiliation:
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Department of Surgery, Division of Emergency Medicine, University of Utah Medical Center, 30 North 1900 East 1C026, Salt Lake City, UT 84132, United States. scott.youngquist@utah.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Analysis of Variance Animals Calcium Chloride / pharmacology* Cardiopulmonary Resuscitation Heart Arrest / complications* Hemodynamics / drug effects Hydrogen-Ion Concentration Hypocalcemia / drug therapy* Lactates / blood Linear Models Random Allocation Statistics, Nonparametric Swine |
| Grant Support | |
ID/Acronym/Agency:
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R01 HL076671/HL/NHLBI NIH HHS; R01 HL076671-01A1/HL/NHLBI NIH HHS; R01 HL076671-02/HL/NHLBI NIH HHS; R01 HL076671-03/HL/NHLBI NIH HHS; R01 HL076671-04/HL/NHLBI NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Lactates; 10043-52-4/Calcium Chloride |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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