A survey demonstrating lack of consensus on the sequence of medications for treatment of hyperkalemia among pediatric critical care providers.
OBJECTIVE
Hyperkalemia is one of the reversible causes of cardiac arrest in children. The Advanced Cardiovascular Life Support guidelines have specific recommendations on the choice and sequence of medications for treatment of life-threatening hyperkalemia. However, the Pediatric Advanced Life Support guidelines have no specific treatment recommendations. The objective of this study was to measure the extent to which opinions diverge among pediatricians on the choice and sequence of medication administration in the management of hyperkalemia during cardiac arrest.


METHODS
Scenario-based survey.


METHODS
A hypothetical hospital area covered by the pediatric rapid response team.


METHODS
A hypothetical scenario of a 7-year old child receiving a blood transfusion who is suddenly unresponsive and found to be in pulseless ventricular tachycardia with stat labs revealing a potassium level of 8.3.


METHODS
A scenario-based survey of PICU fellows and attendings at a PICU Fellows Boot Camp.


RESULTS
Eighty-four fellows and 24 attendings responded to the survey. The response rate was 89%. Calcium was chosen most frequently as the first drug to be administered (calcium chloride, 40/115 [34.8%]; calcium gluconate, 62/115 [53.9%]) while 38 of 115 respondents (33%) chose a drug other than calcium. Only 17 of 115 respondents (15%) would use calcium, sodium bicarbonate, insulin, and dextrose in the advanced cardiovascular life support-recommended sequence. PICU attendings were significantly more likely to administer the advanced cardiovascular life support-recommended sequence than fellows (attendings, 8/24 [33%] vs fellows, 9/84 [11%]; p = 0.007).


CONCLUSIONS
This survey revealed notable variability in the choice and sequence of medications for treatment of life-threatening hyperkalemia with surprisingly few participants in compliance with the advanced cardiovascular life support hyperkalemia guidelines. A standardized approach for pediatric life-threatening hyperkalemia is recommended to improve resuscitation quality.
1Departments of Anesthesiology & Critical Care Medicine and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD. 2Department of Pediatrics, Albert Einstein College of Medicine/Children's Hospital at Montefiore, Bronx, NY. 3Department of Pharmacy, Johns Hopkins Hospital, Baltimore, MD. 4Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.
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Elizabeth A
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Hunt
D002648:Child; D002985:Clinical Protocols; D003422:Critical Care / Q000379:methods*; D004333:Drug Administration Routes; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D006947:Hyperkalemia / Q000188:drug therapy* / Q000209:etiology; D015278:Intensive Care Units, Pediatric; D008020:Life Support Care; D008297:Male; D010372:Pediatrics / Q000379:methods*; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires; D065227:Transfusion Reaction