Abstract
A morbidity and mortality review documented a high occurrence of hyperkalaemia in cardiac arrests associated with rapid blood transfusion, which resulted in further study. In order to simulate events during rapid blood transfusion and cardiac arrest, the central circulation was modeled as a linear one compartment, and used to simulate a child who suffered a hypovolaemic cardiac arrest and was resuscitated with rapid blood transfusion (RBT). The simulation suggested that the combination of RBT and a low cardiac output state could be associated with hyperkalaemia, if the potassium concentration in the plasma fraction of the transfused blood was ≥10 mmol · L−1. In an associated clinical study the plasma potassium concentration during cardiac arrest was documented from a retrospective review of 138 cardiac arrests in a paediatric population. Patients were divided into two groups. The RBT-group received a rapid blood transfusion during resuscitation. The non-RBT group did not receive blood during resuscitation. During cardiac arrest the plasma [K] in the non-RBT group was 5.63 ±2.39 mmol · L−1 compared with 8.23 ±1.99 mmol · L−1 in the RBT-group (P < 0.05). The hyperkalaemia during cardiac arrest in the RBT-group could be explained as a consequence of RBT to a hypovolaemic child with a low cardiac output.
Résumé
Dans une revue de la morbidite, nous avons détecté une prévalence élevée d’ hyperkaliémie lors des arrêts cardiaques associés à des transfusions sanguines rapides (TSR). Nous avons alors utilisé un modèle unicompartimental de la circulation centrale pour simuler un cas d’enfant en choc hypovolémique réanimé à l’aide de TSR. Nous en avons conclu que si la [K+]plasma du sang transfusé était ≥10 mmol · L−1, l’utilisation de TSR combinée à un faible débit cardiaque pouvait entraîner de l’hyperkaliémie. Nous avons alors colligé rétrospectivement la kaliémie mesurée lors de 138 cas d’arrêt cardiaque chez des enfants, pour s’apercevoir quelle s’élevait à 8,23 ±1,99 mmol · I−1 chez ceux qui avaient reçu des TSR durant la réanimation alors qu’elle n’était que de 5,63 ±2,39 chez les autres (P < 0,05). Les TSR employées chez ces enfants hypovolémiques au faible débit cardiaque ont pu contribuer à l’hyperkaliémie observée lors de ‚arrêt cardiaque.
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Abbreviations
- CO:
-
cardiac output
- HctPt :
-
haematocrit of patient
- HctTr :
-
haematocrit of transfusion
- k:
-
rate constant = QTot/VI
- [K]:
-
plasma potassium concentration
- KPt :
-
plasma [K] of patient
- KTr :
-
plasma [K] of transfusion
- KTot :
-
plasma [K] of inflow
- RBCconc:
-
red blood cell concentrate
- RBT:
-
rapid blood transfusion
- rWB:
-
reconstituted whole blood
- QPt :
-
rate of plasma flow of patient
- QTr :
-
rate of plasma flow of transfusion
- QTot :
-
rate of plasma flow of inflow
- VI :
-
volume of central compartment
- VR:
-
venous return
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Brown, K.A., Bissonnette, B. & McIntyre, B. Hyperkalaemia during rapid blood transfusion and hypovolaemic cardiac arrest in children. Can J Anaesth 37, 747–754 (1990). https://doi.org/10.1007/BF03006533
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DOI: https://doi.org/10.1007/BF03006533