Angela C Lee1, Leila L Reduque, Naomi L C Luban, Paul M Ness, Blair Anton, Eugenie S Heitmiller. 1. 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.
Abstract
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.
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.
Authors: Jeannie L Callum; Calvin H Yeh; Andrew Petrosoniak; Mark J McVey; Stephanie Cope; Troy Thompson; Victoria Chin; Keyvan Karkouti; Avery B Nathens; Kimmo Murto; Suzanne Beno; Jacob Pendergrast; Andrew McDonald; Russell MacDonald; Neill K J Adhikari; Asim Alam; Donald Arnold; Lee Barratt; Andrew Beckett; Sue Brenneman; Hina Razzaq Chaudhry; Allison Collins; Margaret Harvey; Jacinthe Lampron; Clarita Margarido; Amanda McFarlan; Barto Nascimento; Wendy Owens; Menaka Pai; Sandro Rizoli; Theodora Ruijs; Robert Skeate; Teresa Skelton; Michelle Sholzberg; Kelly Syer; Jami-Lynn Viveiros; Josee Theriault; Alan Tinmouth; Rardi Van Heest; Susan White; Michelle Zeller; Katerina Pavenski Journal: CMAJ Open Date: 2019-09-03
Authors: Immacolata Andolfo; Roberta Russo; Francesco Manna; Gianluca De Rosa; Antonella Gambale; Soha Zouwail; Nicola Detta; Catia Lo Pardo; Seth L Alper; Carlo Brugnara; Alok K Sharma; Lucia De Franceschi; Achille Iolascon Journal: Haematologica Date: 2016-05-05 Impact factor: 9.941