Electrolyte profiles with induced hypothermia: A sub study of a clinical trial evaluating the duration of hypothermia after cardiac arrest

Kirkegaard, Hans; Grejs, Anders Morten; Gudbjerg, Simon; Duez, Christophe Henri Valdemar; Jeppesen, Anni Nørgaard; Hassager, Christian; Laitio, Timo; Endisch, Christian; Taccone, Fabio Silvio; Skrifvars, Markus B.; Søreide, Eldar

doi:10.1111/aas.14053

Cited by 6 publications

(5 citation statements)

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“…In addition to intravenous fluid administration, other interventions also affect serum sodium levels. Thus, therapeutic hypothermia at 33 °C is associated with a mild increase in natremia [ 36 ]. Finally, in patients with dysnatremia, the speed of natremia correction, and not only the natremia abnormalities themselves, may affect outcomes.…”

Section: Discussionmentioning

confidence: 99%

Dysnatremia at ICU admission and functional outcome of cardiac arrest: insights from four randomised controlled trials

Lascarrou,

Ermel,

Cariou

et al. 2023

Crit Care

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Purpose To evaluate the potential association between early dysnatremia and 6-month functional outcome after cardiac arrest. Methods We pooled data from four randomised clinical trials in post-cardiac-arrest patients admitted to the ICU with coma after stable return of spontaneous circulation (ROSC). Admission natremia was categorised as normal (135–145 mmol/L), low, or high. We analysed associations between natremia category and Cerebral Performance Category (CPC) 1 or 2 at 6 months, with and without adjustment on the modified Cardiac Arrest Hospital Prognosis Score (mCAHP). Results We included 1163 patients (581 from HYPERION, 352 from TTH48, 120 from COMACARE, and 110 from Xe-HYPOTHECA) with a mean age of 63 ± 13 years and a predominance of males (72.5%). A cardiac cause was identified in 63.6% of cases. Median time from collapse to ROSC was 20 [15–29] minutes. Overall, mean natremia on ICU admission was 137.5 ± 4.7 mmol/L; 211 (18.6%) and 31 (2.7%) patients had hyponatremia and hypernatremia, respectively. By univariate analysis, CPC 1 or 2 at 6 months was significantly less common in the group with hyponatremia (50/211 [24%] vs. 363/893 [41%]; P = 0.001); the mCAHP-adjusted odds ratio was 0.45 (95%CI 0.26–0.79, p = 0.005). The number of patients with hypernatremia was too small for a meaningful multivariable analysis. Conclusions Early hyponatremia was common in patients with ROSC after cardiac arrest and was associated with a poorer 6-month functional outcome. The mechanisms underlying this association remain to be elucidated in order to determine whether interventions targeting hyponatremia are worth investigating. Registration ClinicalTrial.gov, NCT01994772, November 2013, 21.

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Section: Discussionmentioning

confidence: 99%

Dysnatremia at ICU admission and functional outcome of cardiac arrest: insights from four randomised controlled trials

Lascarrou,

Ermel,

Cariou

et al. 2023

Crit Care

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“…The development of hyperkalemia during rewarming, however, has been described less commonly [ 31 ], although a recent multicenter study by Kirkegaard et al . [ 32 ] reported mild disturbances in serum K + and other electrolytes, both during hypothermia and rewarming. The present report shows that hypokalemia during hypothermia can convert during rewarming to hyperkalemia that could be life threatening, as in the index case that prompted this study.…”

Section: Discussionmentioning

confidence: 99%

Serum potassium changes during hypothermia and rewarming: a case series and hypothesis on the mechanism

Boubes

Batlle

Tang

et al. 2022

Clinical Kidney Journal

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Introduction Hypokalemia is known to occur in association with therapeutically induced hypothermia and is usually managed by the administration of potassium (K+). Methods We reviewed data from 74 patients who underwent therapeutic hypothermia protocol at our medical institution. Results In 4 patients in whom close data on serum K+ and temperature was available, a strong positive correlation between serum K+ and body temperature was found during the rewarming phase when serum K+ increased. Based on the close positive relationship between serum K+ and total body temperature, we hypothesize that serum K+ falls during hypothermia owing to decreased activity of temperature dependent K+ exit channels that under normal conditions are sufficiently active to match cellular K+ intake via Na+/K+/ATPase. Upon rewarming, reactivation of these channels results in a rapid increase in serum K+ as a result of K+ exit down its concentration gradient. Conclusion Administration of K+ during hypothermia should be done cautiously and avoided during rewarming to avoid potentially life threatening hyperkalemia. K+ exit via temperature dependent K+ channels provides a logical explanation for the rebound hyperkalemia. K+ exit channels may play a bigger role than previously appreciated in the regulation of serum K+ during normal and pathophysiological conditions.

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“…Severe electrolyte disturbances, including hypokalemia, hypomagnesemia, hypophosphatemia, and hypocalcemia, may occur during the cooling phase, which may lead to severe physiologic complications, such as cardiac arrythmias, diaphragmatic weakness, and impaired coagulation. The mechanisms of electrolyte imbalances during hypothermia include intracellular shift and cold-induced diuresis, which subsequently result in renal excretion of potassium, magnesium, and phosphate [ 96 ]. During the rewarming phase, however, these processes reverse, and subsequent extracellular shifts of these electrolytes ensue.…”

Section: Methodsmentioning

confidence: 99%

Temperature Control After Cardiac Arrest: A Narrative Review

et al. 2023

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Cardiac arrest (CA) is a critical public health issue affecting more than half a million Americans annually. The main determinant of outcome post-CA is hypoxic-ischemic brain injury (HIBI), and temperature control is currently the only evidence-based, guideline-recommended intervention targeting secondary brain injury. Temperature control is a key component of a post-CA care bundle; however, conflicting evidence challenges its wide implementation across the vastly heterogeneous population of CA survivors. Here, we critically appraise the available literature on temperature control in HIBI, detail how the evidence has been integrated into clinical practice, and highlight the complications associated with its use and the timing of neuroprognostication after CA. Future clinical trials evaluating different temperature targets, rates of rewarming, duration of cooling, and identifying which patient phenotype benefits from different temperature control methods are needed to address these prevailing knowledge gaps.

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Electrolyte profiles with induced hypothermia: A sub study of a clinical trial evaluating the duration of hypothermia after cardiac arrest

Cited by 6 publications

References 28 publications

Dysnatremia at ICU admission and functional outcome of cardiac arrest: insights from four randomised controlled trials

Dysnatremia at ICU admission and functional outcome of cardiac arrest: insights from four randomised controlled trials

Serum potassium changes during hypothermia and rewarming: a case series and hypothesis on the mechanism

Temperature Control After Cardiac Arrest: A Narrative Review

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