title: The effects of calcium and sodium bicarbonate on severe hyperkalaemia during cardiopulmonary resuscitation: A retrospective cohort study of adult in-hospital cardiac arrest.
abstract: OBJECTIVE
  Calcium and sodium bicarbonate (SB) are frequently used in treating patients with severe hyperkalaemia. We evaluated the efficacy of these medications for the treatment of severe hyperkalaemia during cardiopulmonary resuscitation (CPR). We also hypothesised that the effects of these medications might be associated with serum potassium level during CPR.
  
  
  METHODS
  We conducted a retrospective observational study in a single medical centre. From adult patients who had suffered an in-hospital cardiac arrest from 2006 through 2012, we included those with a serum potassium level>6.5 mEq/L measured during CPR. We used multivariable logistic regression analysis to study the association of calcium/SB with sustained return of spontaneous circulation (ROSC).
  
  
  RESULTS
  Among the 109 patients included in our analysis, 40 (36.7%) patients achieved sustained ROSC, and only four (3.7%) patients survived to hospital discharge. The mean serum potassium level was 7.8 mEq/L. The analysis indicated that administration of SB was positively associated with sustained ROSC when serum potassium level was <7.9 mEq/L (odds ratio [OR]: 10.51; 95% confidence interval [CI]: 1.50-112.89; p: 0.03); administration of calcium and SB was also positively associated with sustained ROSC when serum potassium level was <9.4 mEq/L (OR: 51.11; 95% CI: 3.12-1639.16; p: 0.01).
  
  
  CONCLUSIONS
  The use of calcium and SB might be effective in the treatment of severe hyperkalaemia during cardiac arrest. The efficacy of SB/calcium correlated with serum potassium level. However, because the number of patients included in the analysis was small, this conclusion should be further examined in the future.
authors.affiliation: Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No.7, Zhongshan South Road, Zhongzheng District, Taipei, 100 Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Wang
authors.affiliation: Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No.7, Zhongshan South Road, Zhongzheng District, Taipei, 100 Taiwan.
authors.forename: Chien-Hua
authors.initials: CH
authors.lastname: Huang
authors.affiliation: Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No.7, Zhongshan South Road, Zhongzheng District, Taipei, 100 Taiwan.
authors.forename: Wei-Tien
authors.initials: WT
authors.lastname: Chang
authors.affiliation: Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No.7, Zhongshan South Road, Zhongzheng District, Taipei, 100 Taiwan.
authors.forename: Min-Shan
authors.initials: MS
authors.lastname: Tsai
authors.affiliation: Department of Emergency Medicine, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.
authors.forename: Ping-Hsun
authors.initials: PH
authors.lastname: Yu
authors.affiliation: Departments of Internal Medicine and Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Nuclear Medicine and Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan; National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Yen-Wen
authors.initials: YW
authors.lastname: Wu
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Kuan-Yu
authors.initials: KY
authors.lastname: Hung
authors.affiliation: Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No.7, Zhongshan South Road, Zhongzheng District, Taipei, 100 Taiwan; Department of Emergency Medicine, Lotung Poh-Ai Hospital, Yilan, Taiwan. Electronic address: wjchen1955@ntu.edu.tw.
authors.forename: Wen-Jone
authors.initials: WJ
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D002118:Calcium / Q000627:therapeutic use*; D016887:Cardiopulmonary Resuscitation; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D006947:Hyperkalemia / Q000188:drug therapy* / Q000209:etiology*; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017693:Sodium Bicarbonate / Q000627:therapeutic use*; D013624:Taiwan; D016896:Treatment Outcome
chemical_list: D017693:Sodium Bicarbonate; D002118:Calcium
keywords: Cardiopulmonary resuscitation; Critical Care; Emergency medicine; Heart arrest; Potassium