Journal of Anesthesia

, Volume 2, Issue 2, pp 154–160 | Cite as

Variation in serum ionized calcium on cardiopulmonary resuscitation

  • Satoshi Gando
  • Ichiro Tedo
  • Hirohumi Tujinaga
  • Munehiro Kubota
Original Articles

Abstract

Changes in serum ionized calcium (Ca++) levels during cardiopulmonary resuscitation (CPR) and before and after CaCh administration have been examined and investigated in 30 patients with cardiopulmonary arrest on arrival (dead on arrival patients) when a significant negative correlation was found to exist between the transportation time and aCa++, as the aCa++ level decreased with an increase in the transportation time. Upon arrival, the pH had fallen due to acidosis so that aCa++ and cCa++ levels were virtually normal. After admission, the pH rose as a result of CPR, resulting in a significant drop in both Ca++ levels, so that in most cases resuscitation was not possible. Those successfully resuscitated took over 60 min to return to normal Ca++ levels. Administration of approximately 6.6 mg/kg of CaCl2 led to significant increases in aCa++ and cCa++ to essentially normal levels, even with some patients recording extremely elevated Ca levels, even with some patients recording extremely elevated Ca levels. However, the success rate of resuscitation was not found to show any significant difference according to whether CaCl2 had or had not been administrated.

Thus, it is felt neccessary to re-examine the use of calcium chloride on CPR.

Key words

serum ionized calcium cardiopulmonary resuscitation 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Standards and Guidlines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC), JAMA 255:2905–2989, 1986Google Scholar
  2. 2.
    Best R, Martin GB, Carden DL, Tomlanovich MC, Foreback C, Nowak RM, Michigan D: Ionized calcium during CPR in the canine model. Ann Emerg Med 14:633–635, 1985CrossRefPubMedGoogle Scholar
  3. 3.
    Iba K, Abe K, Kato Y, Tamai K, Goto M, Koyama R, Morii R: Measurement of ionized calcium with new system, SERA250. Igaku no Ayumi 127:838–840, 1983Google Scholar
  4. 4.
    Schwartz RD, McConville BC, Christpherson EF: Serum ionized calcium by specific ion electrode. Clin Chim Acta 31:97–107, 1971CrossRefPubMedGoogle Scholar
  5. 5.
    Lindgarde F: Potentiometric determination of serum ionized calcium in a normal human population. Clin Chim Acta 40:477484,1972CrossRefGoogle Scholar
  6. 6.
    Standards and Guidlines for Cardiopulmonary Resuscitation (CPR) and Emergency cardiac Care (ECC). JAMA 244:453–509, 1980Google Scholar
  7. 7.
    Harrison EE, Amey BD: Use of calcium in electromechanical dissociation. Ann Emerg Med 13:844–845, 1984CrossRefPubMedGoogle Scholar
  8. 8.
    Stueven HA, Thompson BM, Anderson AJ, Aprahamian MS, Tonsfeldt DJ, Darin JC: Effectiveness of calcium chloride in refractory electromechanical dissociation. Ann Emerg Med 13:387, 1984Google Scholar
  9. 9.
    Stueven HA, Thompson BM, Aprahamian MS, Darin JC: Use of calcium in prehospital cardiac arrest. Ann Emerg Med 12:136–139, 1983CrossRefPubMedGoogle Scholar
  10. 10.
    Stueven HA, Thompson BM, Aprahamian MS, Tonsfeldt DJ: Calcium choride: Reassesment of use in asystole. Ann Emerg Med 13:820–822, 1984CrossRefPubMedGoogle Scholar
  11. 11.
    Dembo DH: Calcium in advanced life support. Crit Care Med 9:358–359, 1981CrossRefPubMedGoogle Scholar
  12. 12.
    Shapiro HM: Post-cardiac arrest therapy: Calcium entry blockade and brain resuscitation. Anesthesiology 62:384–387, 1985CrossRefPubMedGoogle Scholar
  13. 13.
    Vaagenes P, Cantadore R, Safer P, Alexander H: The effect of lidofrazine and verapamil on neurological outcome after 10 minutes ventricular fibrillation cardiac arresst in dogs. Crit Care Med 12:228, 1984CrossRefGoogle Scholar
  14. 14.
    Steen PA, Gisvold SE, Milde JH, Newberg LA, Scheithauer BE, Lanier WE: Nimodipine improves outcome when given after complete cerebral ischemia in primate. Anesthesiology 62:406–414, 1985CrossRefPubMedGoogle Scholar
  15. 15.
    Katz AM, Reuter H: Cellular calcium and cardiac cell death. Am J Cardiol 44:188–190, 1979CrossRefPubMedGoogle Scholar
  16. 16.
    Nayler WG: The role of calcium in the ischemic myocardium. Am J Pathol 102:262–270, 1981PubMedGoogle Scholar
  17. 17.
    Drop LJ, Laver MB: Low plasma ionized calcium and response to calcium therapy in critically ill man. Anesthesiology 43:300–306, 1975CrossRefPubMedGoogle Scholar
  18. 18.
    Carpenter MA, Trunkey DD, Holcroft J: Ionizd calcium and magnesium in the baboon: Hemorrhagic shock and resuscitation. Circuratory Shock 5:163–172, 1978Google Scholar
  19. 19.
    Lucas CE, Sennish JC, Ledgerwood AM, Harrigan C: Parathyroid response to hypocalcemia after treatment of hemorrhagic shock. Surgery 96:711–716, 1984PubMedGoogle Scholar
  20. 20.
    Forster J, Querusio L, Burchrd KW, Gann DS: Hypercalcemia in critically ill surgical patients. Ann Surg 202:512–518, 1985CrossRefPubMedGoogle Scholar
  21. 21.
    White BC, Gadzininski DS, Hoehner PJ, Krome C, Hoehner T, White JD, Trombley JH, Michigan D: Effect of flunarizine on canine cerebral cortical blood flow and vascular resistance post cardiac arrest. Ann Emerg Med 11:119–126, 1982CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 1988

Authors and Affiliations

  • Satoshi Gando
    • 2
  • Ichiro Tedo
    • 2
  • Hirohumi Tujinaga
    • 1
  • Munehiro Kubota
    • 1
  1. 1.Department of AnesthesiologySapporo City General HospitalSapporoJapan
  2. 2.Department of Emergency and Clitical Care MedicineSapporo City General HospitalSapporoJapan

Personalised recommendations