Transfusion-Associated Hyperkalemic Cardiac Arrest in Neonatal, Infant, and Pediatric Patients

Hyperkalemic cardiac arrest diagnosis can be elusive and management difficult as the cardiac rhythm restoration is often not achieved until the potassium level decreases to a relatively normal level for the patient who suffers the arrest. Current treatment modalities can take hours to achieve this goal. We describe two patients who survived a witnessed hyperkalemic cardiac arrest after being managed with conventional advanced cardiac life support and unconventionally high doses of intravenous insulin.

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“…25,26 The effect of blood—irradiated or not—on potassium blood concentration is directly related to the rate of infusion and blood age. 19,27…”

Section: Discussionmentioning

confidence: 99%

High-Dose Insulin for Hyperkalemic Cardiac Arrest

Shikhooun¹,

Abdulhadi

Yafes

et al. 2022

American Journal of Therapeutics

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“…Age groups were defined as follows; Group 1: ≤28 days old (neonate), Group 2: 29 days to <1 year old, Group 3: 1-5 years old, Group 4: 6-10 years old, and Group 5: 11-<18 years old. Since many case reports in the literature were reported on neonates, 2,3 ≤28 days old group was analyzed separately in this study. Therefore, 12 patients in each age group, a total of 60 patients were investigated as a control group (non-TAH group).…”

Section: Data Collectionmentioning

confidence: 99%

Transfusion‐associated hyperkalemia in pediatric population: Analyses for risk factors and recommendations

et al. 2022

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Background Transfusion‐associated hyperkalemia (TAH) is a potentially life‐threatening complication of red blood cell (RBC) transfusion. Previously, we reported features of RBC transfusions from 35 pediatric patients (TAH group) who had hyperkalemia with RBC transfusion in one‐year period at four facilities. In this study, we used multivariate analyses and artificial intelligence to compare the TAH group to newly collected control group (non‐TAH group) to identify factors associated with TAH occurrence. Study Design A review of RBC transfusion with TAH was compared to non‐TAH group who did not develop TAH with RBC transfusion at each facility during the same one‐year period. The non‐TAH group included 12 patients each in 5 age groups. Wilcoxon rank‐sum tests recursive feature elimination, least absolute shrinkage, and selection operator (LASSO), and other artificial intelligence techniques were employed to identify the most salient features associated with predicting specific clinical outcomes for TAH occurrence. Results/Findings Pre‐transfusion creatinine, comorbidities of kidney and/or liver dysfunctions, and total transfused volume within 12 h (tV‐12) per kg and per estimated total blood volume (eTBV) showed statistically significant differences between TAH and non‐TAH groups. Multivariate analysis revealed the biggest factor in TAH occurrence was tV‐12/kg followed by age of RBC units. The thresholds of risks were tV‐12/kg of 30 ml/kg, tV‐12/eTBV of 30%, and RBC unit age of 7.95 days. Conclusions The study findings suggest that the biggest factor on TAH occurrence is tV‐12/kg. More importantly, 30% of eTBV transfusion could cause TAH in patients with multiple comorbidities.

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“…Hyperkalaemia represents a key component of the pRBC storage lesion in which biochemical, metabolic and structural alterations occur within pRBCs in a time-dependent fashion, with a 3.76-fold increase in potassium concentration observed after three weeks [17 ▪ ]. An in-vitro study demonstrated a direct link between supernatant from pRBCs stored for longer periods, hyperkalaemia and adverse electrocardiogram changes [18].…”

Section: Mechanisms Of Biochemical Disturbancementioning

confidence: 99%

“…With their smaller circulating volumes, paediatric patients are at particular risk of transfusion-related hyperkalemic cardiac arrest (TRHCA) [17 ▪ ], with increased age of pRBCs and concomitant acidosis or hypocalcaemia compounding the risk [52]. A single unit of pRBCs has been shown to raise [K] by 0.09 mmol/l among critically ill adults [53 ▪ ].…”

Section: Hyperkalaemiamentioning

confidence: 99%

Biochemical disturbance in damage control resuscitation: mechanisms, management and prognostic utility

Milne¹,

Radhakrishnan²

2022

Current Opinion in Anaesthesiology

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Purpose of reviewWith advances in resuscitative techniques, trauma patients are surviving increasingly severe injuries and physiological insult. Timely recognition of futility remains important in terms of patient dignity and resource preservation yet is increasingly challenging in the face of these advances. The understanding of biochemical derangement from pathophysiological processes of trauma and iatrogenic effects of resuscitation has expanded recently.Recent findingsAcidosis and hypocalcaemia have been recognized as important contributors to mortality among trauma patients. Although less well recognized and studied, critical injury and high blood product volume resuscitation render patients vulnerable to life-threatening hyperkalaemia. The methods of correcting disruptions to acid–base and electrolyte homeostasis during damage control resuscitation have changed little recently and often rely on evidence from undifferentiated populations. Biochemical disturbances have value as ancillary predictors of futility in trauma resuscitation.SummaryThese findings will contribute to a greater understanding among anaesthesiologists of the causative mechanisms and effects of biochemical derangement after severe injury and aid them in the delivery of well tolerated and effective damage control resuscitation. Gaps in the evidence base are highlighted to encourage future work.

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Transfusion-Associated Hyperkalemic Cardiac Arrest in Neonatal, Infant, and Pediatric Patients

Cited by 17 publications

References 103 publications

High-Dose Insulin for Hyperkalemic Cardiac Arrest

High-Dose Insulin for Hyperkalemic Cardiac Arrest

Transfusion‐associated hyperkalemia in pediatric population: Analyses for risk factors and recommendations

Biochemical disturbance in damage control resuscitation: mechanisms, management and prognostic utility

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