HYPERKALEMIA DURING RAPID BLOOD-TRANSFUSION AND HYPOVOLEMIC CARDIAC-ARREST IN CHILDREN

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. © 1990 Canadian Anesthesiologists.