title: Serum potassium concentration predicts brain hypoxia on CT after avalanche-induced cardiac arrest.
abstract: BACKGROUND
  Brain anoxia after complete avalanche burial and cardiac arrest (CA) may occur despite adequate on-site triage.
  
  
  OBJECTIVE
  To investigate clinical and biological parameters associated with brain hypoxia in a cohort of avalanche victims with whole body computed tomographic (CT) scan.
  
  
  METHODS
  Retrospective study of patients with CA and whole body CT scan following complete avalanche burial admitted in a level-I trauma center.
  
  
  RESULTS
  Out of 19 buried patients with whole body CT scan, eight patients had refractory CA and 11 patients had pre-hospital return of spontaneous circulation. Six patients survived at hospital discharge and only two had good neurologic outcome. Twelve patients had signs of brain hypoxia on initial CT scan, defined as brain edema, loss of gray/white matter differentiation and/or hypodensity of basal ganglia. No clinical pre-hospital parameter was associated with brain anoxia. Serum potassium concentration at admission was higher in patients with brain anoxia as compared to patients with normal CT scan: 5.5 (4.1-7.2) mmol/L versus 3.3 (3.0-4.2) mmol/L, respectively (P<.01). A threshold of 4.35 mmol/L serum potassium had 100% specificity to predict brain anoxia on brain CT scan.
  
  
  CONCLUSIONS
  Serum potassium concentration had good predictive value for brain anoxia after complete avalanche burial. This finding further supports the use of serum potassium concentration for extracorporeal life support insertion at hospital admission in this context.
authors.affiliation: Pôle Imagerie, Centre Hospitalier Universitaire de Grenoble, CS 10217, F-38043 Grenoble, France.
authors.forename: Julien G
authors.initials: JG
authors.lastname: Cohen
authors.affiliation: Pôle Anesthésie Réanimation, Centre Hospitalier Universitaire de Grenoble, CS 10217, F-38043 Grenoble, France.
authors.forename: Yvonnick
authors.initials: Y
authors.lastname: Boué
authors.affiliation: Pôle Santé Publique, Centre Hospitalier Universitaire de Grenoble, CS 10217, F-38043, Grenoble, France; Laboratoire Techniques de l'Ingénierie Médicale et de la Complexité, CNRS UMR5525, F-38043 Grenoble, France.
authors.forename: Bastien
authors.initials: B
authors.lastname: Boussat
authors.affiliation: Pôle Imagerie, Centre Hospitalier Universitaire de Grenoble, CS 10217, F-38043 Grenoble, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Reymond
authors.affiliation: Pôle Imagerie, Centre Hospitalier Universitaire de Grenoble, CS 10217, F-38043 Grenoble, France; Grenoble Institut des Neurosciences, INSERM U836, F-38043 Grenoble, France; Grenoble Alpes Université, F-38043 Grenoble, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Grand
authors.affiliation: Pôle Urgence-Médecine Aiguë, Centre Hospitalier Universitaire de Grenoble, CS 10217, F-38043 Grenoble, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Blancher
authors.affiliation: Pôle Imagerie, Centre Hospitalier Universitaire de Grenoble, CS 10217, F-38043 Grenoble, France; Grenoble Alpes Université, F-38043 Grenoble, France.
authors.forename: Gilbert R
authors.initials: GR
authors.lastname: Ferretti
authors.affiliation: Pôle Anesthésie Réanimation, Centre Hospitalier Universitaire de Grenoble, CS 10217, F-38043 Grenoble, France; Grenoble Institut des Neurosciences, INSERM U836, F-38043 Grenoble, France; Grenoble Alpes Université, F-38043 Grenoble, France. Electronic address: PBouzat@chu-grenoble.fr.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bouzat
mesh_terms: D000328:Adult; D001237:Asphyxia / Q000097:blood / Q000150:complications*; D055875:Avalanches; D015415:Biomarkers / Q000097:blood; D005260:Female; D006323:Heart Arrest / Q000097:blood / Q000209:etiology*; D006801:Humans; D002534:Hypoxia, Brain / Q000097:blood / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D011188:Potassium / Q000097:blood*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D015415:Biomarkers; D011188:Potassium