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Transfusion-associated hyperkalemic cardiac arrest in pediatric patients receiving massive transfusion.
MedLine Citation:
PMID:  23581425     Owner:  NLM     Status:  Publisher    
BACKGROUND: Hyperkalemic cardiac arrest is a potential complication of massive transfusion in children. Our objective was to identify risk factors and potential preventive measures by reviewing the literature on transfusion-associated hyperkalemic cardiac arrest (TAHCA) in the pediatric population. STUDY DESIGN AND METHODS: Literature searches were performed in MEDLINE and the Cochrane Database of Systematic Reviews. RESULTS: We identified nine case reports of pediatric patients who had experienced cardiac arrest during massive transfusion. Serum potassium concentration was reported in eight of those reports; the mean was 9.2 ± 1.8 mmol/L. Risk factors for TAHCA noted in the case reports included infancy (n = 6); age of red blood cells (RBCs; n = 5); site of transfusion (n = 5); and the presence of comorbidities such as hyperkalemia, hypocalcemia, acidemia, and hypotension (n = 9). We also identified 13 clinical studies that examined potassium levels associated with transfusion. Of those 13, five studied routine transfusion, two were registries, and six examined massive transfusion. CONCLUSIONS: Key points identified from this literature search are as follows: 1) Case reports are skewed toward infants and neonates in particular and 2) the rate of blood transfusion, more so than total volume, cardiac output, and the site of infusion, are key factors in the development of TAHCA. Measures to reduce the risk of TAHCA in young children include anticipating and replacing blood loss before significant hemodynamic compromise occurs, using larger-bore (>23-gauge) peripheral intravenous catheters rather than central venous access, checking and correcting electrolyte abnormalities frequently, and using fresher RBCs for massive transfusion.
Angela C Lee; Leila L Reduque; Naomi L C Luban; Paul M Ness; Blair Anton; Eugenie S Heitmiller
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-4-15
Journal Detail:
Title:  Transfusion     Volume:  -     ISSN:  1537-2995     ISO Abbreviation:  Transfusion     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-4-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0417360     Medline TA:  Transfusion     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2013 American Association of Blood Banks.
Division of Anesthesiology and Pain Medicine, Division of Laboratory Medicine, Children's National Medical Center; Department of Anesthesiology and Pediatrics, Department of Pediatrics and Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC; Transfusion Medicine Division, Department of Pathology, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine; Clinical Liaison for Library Services, Welch Medical Library, Johns Hopkins University, Baltimore, Maryland.
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