Intra-patient potassium variability after hypothermic cardiac arrest: a multicentre, prospective study.
Cardiac arrest
ECMO
ECPR
Gasometer analyser, hypothermia, accidental
Potassium
Resuscitation
Triage
Journal
Scandinavian journal of trauma, resuscitation and emergency medicine
ISSN: 1757-7241
Titre abrégé: Scand J Trauma Resusc Emerg Med
Pays: England
ID NLM: 101477511
Informations de publication
Date de publication:
16 Dec 2019
16 Dec 2019
Historique:
received:
17
09
2019
accepted:
03
12
2019
entrez:
18
12
2019
pubmed:
18
12
2019
medline:
25
3
2020
Statut:
epublish
Résumé
To date, the decision to set up therapeutic extra-corporeal life support (ECLS) in hypothermia-related cardiac arrest is based on the potassium value only. However, no information is available about how the analysis should be performed. Our goal was to compare intra-individual variation in serum potassium values depending on the sampling site and analytical technique in hypothermia-related cardiac arrests. Adult patients with suspected hypothermia-related refractory cardiac arrest, admitted to three hospitals with ECLS facilities were included. Blood samples were obtained from the femoral vein, a peripheral vein and the femoral artery. Serum potassium was analysed using blood gas (BGA) and clinical laboratory analysis (CL). Of the 15 consecutive patients included, 12 met the principal criteria, and 5 (33%) survived. The difference in average potassium values between sites or analytical method used was ≤1 mmol/L. The agreement between potassium values according to the three different sampling sites was poor. The ranges of the differences in potassium using BGA measurement were - 1.6 to + 1.7 mmol/L; - 1.18 to + 2.7 mmol/L and - 0.87 to + 2 mmol/L when comparing respectively central venous and peripheral venous, central venous and arterial, and peripheral venous and arterial potassium. We found important and clinically relevant variability in potassium values between sampling sites. Clinical decisions should not rely on one biological indicator. However, according to our results, the site of lowest potassium, and therefore the preferred site for a single potassium sampling is central venous blood. The use of multivariable prediction tools may help to mitigate the risks inherent in the limits of potassium measurement. ClinicalTrials.gov Identifier: NCT03096561.
Sections du résumé
BACKGROUND
BACKGROUND
To date, the decision to set up therapeutic extra-corporeal life support (ECLS) in hypothermia-related cardiac arrest is based on the potassium value only. However, no information is available about how the analysis should be performed. Our goal was to compare intra-individual variation in serum potassium values depending on the sampling site and analytical technique in hypothermia-related cardiac arrests.
METHODS
METHODS
Adult patients with suspected hypothermia-related refractory cardiac arrest, admitted to three hospitals with ECLS facilities were included. Blood samples were obtained from the femoral vein, a peripheral vein and the femoral artery. Serum potassium was analysed using blood gas (BGA) and clinical laboratory analysis (CL).
RESULTS
RESULTS
Of the 15 consecutive patients included, 12 met the principal criteria, and 5 (33%) survived. The difference in average potassium values between sites or analytical method used was ≤1 mmol/L. The agreement between potassium values according to the three different sampling sites was poor. The ranges of the differences in potassium using BGA measurement were - 1.6 to + 1.7 mmol/L; - 1.18 to + 2.7 mmol/L and - 0.87 to + 2 mmol/L when comparing respectively central venous and peripheral venous, central venous and arterial, and peripheral venous and arterial potassium.
CONCLUSIONS
CONCLUSIONS
We found important and clinically relevant variability in potassium values between sampling sites. Clinical decisions should not rely on one biological indicator. However, according to our results, the site of lowest potassium, and therefore the preferred site for a single potassium sampling is central venous blood. The use of multivariable prediction tools may help to mitigate the risks inherent in the limits of potassium measurement.
TRIAL REGISTRATION
BACKGROUND
ClinicalTrials.gov Identifier: NCT03096561.
Identifiants
pubmed: 31842931
doi: 10.1186/s13049-019-0694-3
pii: 10.1186/s13049-019-0694-3
pmc: PMC6916106
doi:
Substances chimiques
Potassium
RWP5GA015D
Banques de données
ClinicalTrials.gov
['NCT03096561']
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
113Références
Prehosp Emerg Care. 2019 Jan-Feb;23(1):90-93
pubmed: 30118356
Resuscitation. 2019 Jun;139:222-229
pubmed: 31022496
J Cardiothorac Vasc Anesth. 2016 Dec;30(6):1693-1697
pubmed: 27727083
Crit Rev Clin Lab Sci. 2017 Jan;54(1):59-72
pubmed: 28013559
Resuscitation. 2015 Aug;93:118-23
pubmed: 26095302
Biochem Med (Zagreb). 2013;23(2):193-200
pubmed: 23894864
N Engl J Med. 1997 Nov 20;337(21):1500-5
pubmed: 9366581
Crit Rev Clin Lab Sci. 2015;52(2):45-55
pubmed: 25319088
Clin Biochem. 2013 May;46(7-8):561-4
pubmed: 23391635
Stat Methods Med Res. 1999 Jun;8(2):135-60
pubmed: 10501650
Am J Emerg Med. 2016 May;34(5):794-7
pubmed: 26838187
Am J Emerg Med. 2016 Jul;34(7):1315-6
pubmed: 27198903
Resuscitation. 2014 Sep;85(9):1192-6
pubmed: 24971508
Circulation. 1991 Aug;84(2):960-75
pubmed: 1860248
Am J Crit Care. 1998 Nov;7(6):439-43
pubmed: 9805118
J Trauma. 1996 Mar;40(3):483-5
pubmed: 8601876
JAMA. 1990 Oct 10;264(14):1842-5
pubmed: 2402043
Wilderness Environ Med. 2014 Dec;25(4):425-45
pubmed: 25443771
N Engl J Med. 2012 Nov 15;367(20):1930-8
pubmed: 23150960
N Engl J Med. 1990 May 3;322(18):1290-2
pubmed: 2325722
Resuscitation. 2017 Sep;118:35-42
pubmed: 28689048
Intensive Care Med. 2016 Dec;42(12):1922-1934
pubmed: 27647331
Resuscitation. 2019 Jan;134:161-162
pubmed: 30572067
Heart Lung. 2017 Jul - Aug;46(4):246-250
pubmed: 28477952
Scand J Trauma Resusc Emerg Med. 2016 Sep 15;24(1):111
pubmed: 27633781
Resuscitation. 2015 Oct;95:148-201
pubmed: 26477412
Am J Emerg Med. 2019 Jun;37(6):1048-1053
pubmed: 30131206
Resuscitation. 2019 Jun;139:361-362
pubmed: 31005589
J Trauma. 1987 Oct;27(10):1107-12
pubmed: 3669105
Clin Chem. 2019 Mar;65(3):378-380
pubmed: 30819789
Cryobiology. 2017 Oct;78:128-129
pubmed: 28754211
Resuscitation. 2013 May;84(5):539-46
pubmed: 23123559
Resuscitation. 2018 May;126:58-64
pubmed: 29481910
Praxis (Bern 1994). 1996 Oct 8;85(41):1275-82
pubmed: 8966421
J Clin Lab Anal. 2018 Mar 3;:null
pubmed: 29500827