List Archives

Wed Mar 19 17:19:54 GMT 2008

that would be the right way to go about it. when i get back from leave
I'll saddle up and fight this battle...
rangraj

On Wed, Mar 19, 2008 at 10:41 PM, A M Batchelor
<a.m.batchelor at newcastle.ac.uk> wrote:
> We have a max of 30 mins out of the fridge before administration after which it has to be returned unused to blood bank..........and someone appears to chastise you for wasting valuable resources and gives you a hard time (quite rightly) about the poor caring soul who donated it ...etc etc etc
>
>
>  Anna
>
>  -----Original Message-----
>  From: Rangraj Setlur [mailto:rangraj at gmail.com]
>
>
> Sent: 19 March 2008 17:05
>  To: A M Batchelor
>  Cc: Ivan Hronek; ccm-l at ccm-l.org; Anesthideas at yahoogroups.com; trauma-list at trauma.org; sprung.juraj at mayo.edu
>  Subject: Re: {Disarmed} [ccm-l] HyperK arrest w. PRBCs ?
>
>  One thing we could be doing wrong is that our blood bags sit in the OR at room temperature after arriving till we are ready to give them instead of being in the cold chain till the last moment.rangraj
>
>  On Wed, Mar 19, 2008 at 9:24 PM, A M Batchelor <a.m.batchelor at newcastle.ac.uk> wrote:
>  > Malignant phaeos can be interesting ......
>  >
>  >  One of my surgical colleagues still goes pale when I recount the story of the 1 stuck ...literally ....with lots of blood vessels with short connections directly onto the front of the aorta .........42 litres blood loss .......I counted the sucker bottles at the end ....all other methods of estimation having been ignored hours before.
>  >
>  >  Blood gases (machine does electrolytes and Hb too) monitored
>  > regularly  K never a problem ....lots of other things were mind :-)
>  >
>  >  Patient went home ....evetually ...but sadly has recurrence of phaeo
>  >
>  >  Glad I don't see too many of them.
>  >
>  >  Are there any differences in blood collection and storage or administration where you are ??
>  >
>  >  Anna
>  >
>  >
>  >
>  >  -----Original Message-----
>  >  From: Rangraj Setlur [mailto:rangraj at gmail.com]
>  >  Sent: 19 March 2008 14:05
>  >  To: A M Batchelor
>  >  Cc: Ivan Hronek; ccm-l at ccm-l.org; Anesthideas at yahoogroups.com;
>  > trauma-list at trauma.org; sprung.juraj at mayo.edu
>  >  Subject: Re: {Disarmed} [ccm-l] HyperK arrest w. PRBCs ?
>  >
>  >  I've seen hyperkalemic cardiac arrest from massive blood transfusions three times, once in a ruptured AAA, once in a massive liver hemangioma and once in a malignant pheochromocytoma when the surgeon went through the IVC  around which the tumour was wrapped. In all cases the pateints had a preterminal K of 9 or 10 and died with sine waves. It could ,of course be argued that if they hadnt died of hyperkalemia then they would have died of hypothermia coagulopathy acidosis.
>  >  rangraj
>  >
>  >  On Wed, Mar 19, 2008 at 7:18 PM, A M Batchelor <a.m.batchelor at newcastle.ac.uk> wrote:
>  >  > Hmmm
>  >  >
>  >  >  I thought every anaesthetist on the planet ...and indeed medical students too knew about this.
>  >  >
>  >  >  Another one of those bits of information that everyone knows and in fact is a vanishingly rare problem ....rather like hypoxic drive .....
>  >  >
>  >  >  An average of less than 1 patient per year in the Mayo clinic which cannot have a small case load rather puts it in perspective.
>  >  >
>  >  >  In 25 years in anaesthesia and intensive care ....with my fair share of massive transfusions I have yet to see it.
>  >  >
>  >  >  We used to give Ca or HCO3 to prevent this until we worked out that in fact as soon as the cells warm up they take the K back up and it really isn't much of a problem.  Confirmed by in theatre measurements of blood gases and electrolytes.
>  >  >
>  >  >  Haven't read the paper but their conclusion in the abstract about other conditions eg hypothermia and low cardiac output are I think important.
>  >  >
>  >  >  I would hate to return to the days when people religiously gave HCO3 for this potential problem and the patients then spent 5 days alkalotic because they cannot clear an alkaline (or Na) load very easily.
>  >  >
>  >  >  Anna
>  >  >  Oh G-d I am now old enough to see the wheels being re-invented ........
>  >  >
>  >  >
>  >  >
>  >  >  -----Original Message-----
>  >  >  From: ccm-l-bounces at ccm-l.org [mailto:ccm-l-bounces at ccm-l.org] On
>  > > Behalf Of Ivan Hronek  >  Sent: 19 March 2008 01:24  >  To:
>  > ccm-l at ccm-l.org; Anesthideas at yahoogroups.com  >  Cc:
>  > trauma-list at trauma.org; sprung.juraj at mayo.edu  >  Subject: {Disarmed}
>  > [ccm-l] HyperK arrest w. PRBCs ?
>  >  >
>  >  >  Anesth Analg 2008; 106:1062-1069  complete article anyone ?
>  >  >
>  >  >  Cardiac Arrests Associated with Hyperkalemia During Red Blood Cell
>  > > Transfusion: A Case Series  >  >  Hugh M. Smith, MD, PhD*, Stacy J.
>  > Farrow, SRNA*, Joel D. Ackerman,  > MD*, James R. Stubbs, MD  >
>  > {dagger}<http://www.anesthesia-analgesia.org/math/dagger.gif> , and  >
>  > Juraj Sprung, MD, PhD*  >  >  >From the Departments of *Anesthesiology
>  > and  {dagger}<http://www.anesthesia-analgesia.org/math/dagger.gif> Transfusion Medicine, College of Medicine, Mayo Clinic, Rochester, Minnesota.
>  >  >
>  >  >  Address correspondence and reprint requests to Juraj Sprung, MD, PhD, Department of Anesthesiology, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. Address e-mail to sprung.juraj at mayo.edu .
>  >  >
>  >  >  Abstract
>  >  >
>  >  >  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%.
>  >  >
>  >  >  CONCLUSION: 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.
>  >  >
>  >  >
>  >  >
>  >  >
>  >  >
>  >  >  Ivan Hronek MD
>  >  >
>  >  >  SFMC, Los Angeles
>  >  >
>  >  >  cell: 310 487-3288
>  >  >
>  >  >  http://health.groups.yahoo.com/group/Anesthideas/
>  >  >
>  >  >  Don't fight darkness. Bring the light, and darkness will disappear.
>  >  >
>  >  >  Maharishi Mahesh Yogi
>  >  >
>  >  >  Confidentiality Notice: This transmission and any attached documents may be confidential and contain information protected by State and Federal Medical Privacy statutes and is legally privileged. They are intended for use only by the addressee. If you are not the intended recipient of this transmission, or an agent of the intended recipient, you are prohibited from reading, disclosing, printing, saving, copying, using, or otherwise disseminating any information contained in this transmission. If you received this transmission in error, please accept our apologies and notify me at  ivanhronek at yahoo.com <mailto:ivanhronek at yahoo.com>  and delete the entire message and its attachments. Thank you. Disclaimer: this message contains the personal views of the author. The author will not be responsible in any way for procedures or approaches perfomed in the way suggested in this note.
>  >  >
>  >  >
>  >  >
>  >  >
>  >  >  ________________________________
>  >  >
>  >  >  Looking for last minute shopping deals? Find them fast with Yahoo!
>  >  > Search.
>  >  >
>  > <http://us.rd.yahoo.com/evt=51734/*http://tools.search.yahoo.com/newse
>  >  > arch/category.php?category=shopping>
>  >  >  _______________________________________________
>  >  >  ccm-l mailing list
>  >  >  ccm-l at ccm-l.org
>  >  >  http://ccm-l.org/mailman/listinfo/ccm-l
>  >  >
>  >
>  >
>  >
>  >  --
>  >  Lt Col Rangraj Setlur
>  >  Associate Professor
>  >  Department of Anaesthesiology and Critical Care Armed Forces Medical
>  > College Pune India
>  >
>
>
>
>  --
>  Lt Col Rangraj Setlur
>  Associate Professor
>  Department of Anaesthesiology and Critical Care Armed Forces Medical College Pune India
>

-- 
Lt Col Rangraj Setlur
Associate Professor
Department of Anaesthesiology and Critical Care
Armed Forces Medical College
Pune
India

List Archives

For your convenience, find the Trauma List Archive Below

{Disarmed} [ccm-l] HyperK arrest w. PRBCs ?