Transfusion‐associated hyperkalemic cardiac arrest in pediatric patients receiving massive transfusion

Lee, Angela C; Reduque, Leila L.; Luban, Naomi L.C.; Ness, Paul M.; Anton, Blair; Heitmiller, Eugenie S.

doi:10.1111/trf.12192

Cited by 103 publications

(69 citation statements)

References 40 publications

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“…It has been demonstrated that stored blood increases its extracellular potassium level over time. Within the first week levels were less than 20 mEq/L, and they rose to greater than 40 mEq/L after two weeks of storage [25]. This is thought to be an under-appreciated risk in clinical practice, as highlighted by a report of cardiac arrests in pediatric patients receiving massive transfusions [25].…”

Section: Blood Transfusionsmentioning

confidence: 96%

Postoperative hyperkalemia

Ayach

Nappo

Paugh‐Miller

et al. 2015

European Journal of Internal Medicine

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Hyperkalemia occurs frequently in hospitalized patients and is of particular concern for those who have undergone surgery, with postoperative care provided by clinicians of many disciplines. This review describes the normal physiology and how multiple perioperative factors can disrupt potassium homeostasis and lead to severe elevations in plasma potassium concentration. The pathophysiologic basis of diverse causes of hyperkalemia was used to broadly classify etiologies into those with altered potassium distribution (e.g. increased potassium release from cells or other transcellular shifts), reduced urinary excretion (e.g. reduced sodium delivery, volume depletion, and hypoaldosteronism), or an exogenous potassium load (e.g. blood transfusions). Surgical conditions of particular concern involve: rhabdomyolysis from malpositioning, trauma or medications; bariatric surgery; vascular procedures with tissue ischemia; acidosis; hypovolemia; and volume or blood product resuscitation. Certain acute conditions and chronic co-morbidities present particular risk. These include chronic kidney disease, diabetes mellitus, many outpatient preoperative medications (e.g. beta blockers, salt substitutes), and inpatient agents (e.g. succinylcholine, hyperosmolar volume expanders). Clinicians need to be aware of these pathophysiologic mechanisms for developing perioperative hyperkalemia as many of the risks can be minimized or avoided.

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Section: Blood Transfusionsmentioning

confidence: 96%

Postoperative hyperkalemia

Ayach

Nappo

Paugh‐Miller

et al. 2015

European Journal of Internal Medicine

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“…Several cases of whole blood transfusion leading to cardiac arrest and death in infants have been described. [23][24][25][26][27] The ABCB6 FP mutants overexpressed in HEK-293 cells showed no difference in accumulation of mRNA or protein, or in peripheral membrane immunolocalization as compared to WT ABCB6, and as previously demonstrated for the ABCB6 FP variant R375Q.…”

Section: Discussionmentioning

confidence: 78%

Functional characterization of novel ABCB6 mutations and their clinical implications in familial pseudohyperkalemia

et al. 2016

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“…8 Particular consideration should be directed towards hyperkalemia and hypocalcemia which can result from large-volume blood transfusions. 9 Vigilance is needed to detect early signs of hyperkalemia (peak T waves, shortened QT interval, ST depression etc.). Furthermore, some blood preparation strategies, such as irradiation to reduce the risk of graft vs host reaction, may increase the risk of hyperkalemia.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, his intravenous methylprednisolone was transitioned to oral prednisolone that was slowly tapered over three months to 0.2 mgÁkg -1 Áday -1 . He was restarted on his preoperative tacrolimus with a targeted level of [8][9][10][11][12] ngÁmL -1 , and his mycophenolate dose increased to 400 mg q 12 hr postoperatively. Cefazolin was continued postoperatively for antibiotic prophylaxis, and daily cotrimoxazole (trimethoprim/sulfamethoxazole) was administered for one year.…”

Section: Clinical Casementioning

confidence: 99%

Anesthetic management of the first pediatric bilateral hand transplant

Gurnaney

Fiadjoe

Levin

et al. 2016

Can J Anesth/J Can Anesth

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Purpose The purpose of this case report is to describe the anesthetic and case management of the first vascularized composite allograft pediatric bilateral hand transplant. Clinical details Our patient was an eight-year-old male with a medical history of Staphylococcus aureus sepsis at one year of age that resulted in end-stage renal disease as well as bilateral upper and lower extremity amputations. After referral for bilateral hand transplantation, the transplantation team, with expertise in all aspects of perioperative care (surgery, anesthesiology, nephrology, renal transplantation, pediatric intensive care, and therapeutic pharmacy), was consulted to help develop anesthetic and other perioperative protocols for surgery. Prior to activation of the transplantation team, the lead surgeon evaluated potential donors by comparing a threedimensional printed model of the recipient's forearm with the donor's upper extremities to ensure an adequate match. The anesthesia team inserted bilateral ultrasound-guided infraclavicular catheters to provide a sympathetic block to facilitate blood flow to the upper extremities and to provide both intraoperative and postoperative pain control. The patient remained in the operating room for 13 hr 37 min for a surgical time of ten hours 39 min. He remained in the hospital for 34 days after the procedure and was then transferred to an inpatient rehabilitation facility for a further 15 days. The patient is currently doing well in a postoperative rehabilitation program. He has demonstrated motor power to the hands using the forearm muscles but is not expected to reach his maximum sensory function for at least one to two years. Conclusion This report describes the anesthetic management of the first pediatric bilateral hand transplant. This procedure required considerable preoperative planning and communication between various teams to ensure all resources needed to deliver the care for this complex and novel transplant surgery were readily available. RésuméObjectif L'objectif de cette présentation de cas est de décrire la prise en charge anesthésique et la gestion du cas de la première greffe bilatérale des mains chez un enfant à partir d'une allogreffe de tissu composite. Détails cliniques Notre patient était un garçon de huit ans présentant des antécédents médicaux de sepsis dû à un staphylocoque doré contracté à l'âge d'un an, qui a entraîné une insuffisance rénale terminale ainsi que l'amputation bilatérale des membres supérieurs et inférieurs. Après son aiguillage pour une greffe bilatérale des mains, l'équipe de transplantation, forte d'une vaste expertise en soins périopératoires (chirurgie, anesthésiologie, néphrologie, transplantation rénale, soins intensifs pédiatriques et pharmacie thérapeutique), a été consultée afin de mettre au point des protocoles

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Transfusion‐associated hyperkalemic cardiac arrest in pediatric patients receiving massive transfusion

Cited by 103 publications

References 40 publications

Postoperative hyperkalemia

Postoperative hyperkalemia

Functional characterization of novel ABCB6 mutations and their clinical implications in familial pseudohyperkalemia

Anesthetic management of the first pediatric bilateral hand transplant

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