Cardiac arrests associated with hyperkalemia during red blood cell transfusion: a case series.
BACKGROUND
Transfusion-associated hyperkalemic cardiac arrest is a serious complication of rapid red blood cell (RBC) administration. We examined the clinical scenarios and outcomes of patients who developed hyperkalemia and cardiac arrest during rapid RBC transfusion.


METHODS
We retrospectively reviewed the Mayo Clinic Anesthesia Database between November 1, 1988, and December 31, 2006, for all patients who developed intraoperative transfusion-associated hyperkalemic cardiac arrest.


RESULTS
We identified 16 patients with transfusion-associated hyperkalemic cardiac arrest, 11 adult and 5 pediatric. The majority of patients underwent three types of surgery: cancer, major vascular, and trauma. The mean serum potassium concentration measured during cardiac arrest was 7.2 +/- 1.4 mEq/L (range, 5.9-9.2 mEq/L). The number of RBC units administered before cardiac arrest ranged between 1 (in a 2.7 kg neonate) and 54. Nearly all patients were acidotic, hyperglycemic, hypocalcemic, and hypothermic at the time of arrest. Fourteen (87.5%) patients received RBC via central venous access. Commercial rapid infusion devices (pumps) were used in 8 of 11 (72.7%) of the adult patients, but RBC units were rapidly administered (pressure bags, syringe pumped) in all remaining patients. Mean resuscitation duration was 32 min (range, 2-127 min). The in-hospital survival rate was 12.5%.


CONCLUSIONS
The pathogenesis of transfusion-associated hyperkalemic cardiac arrest is multifactorial and potassium increase from RBC administration is complicated by low cardiac output, acidosis, hyperglycemia, hypocalcemia, and hypothermia. Large transfusion of banked RBCs and conditions associated with massive hemorrhage should raise awareness of the potential for hyperkalemia and trigger preventative measures.
Smith
Hugh M
HM
Department of Anesthesiology, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Farrow
Stacy J
SJ
Ackerman
Joel D
JD
Stubbs
James R
JR
Sprung
Juraj
J
D000328:Adult; D002648:Child; D004562:Electrocardiography; D017707:Erythrocyte Transfusion / Q000009:adverse effects* / Q000379:methods; D006323:Heart Arrest / Q000209:etiology* / Q000401:mortality; D006801:Humans; D006947:Hyperkalemia / Q000150:complications / Q000209:etiology*; D007431:Intraoperative Complications / Q000628:therapy*; D011188:Potassium / Q000097:blood; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000145:classification; D016019:Survival Analysis; D017741:Survivors
D011188:Potassium