Potassium-induced conversion of ventricular fibrillation after aortic declamping

Sm, Almdahl; Damstuen, Jens; Eide, Magne; Mølstad, Per; Halvorsen, Per Steinar; Veel, Terje

doi:10.1093/icvts/ivs455

Cited by 12 publications

(12 citation statements)

References 25 publications

(36 reference statements)

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“…Although several studies have described successful chemical conversion of VF during cardiopulmonary bypass using potassium, successful chemical conversion of VF during conventional CPR has been seldom addressed. Interestingly, 50% of the K‐lido group animals achieved ROSC without electrical countershock in this study.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have indicated that inducing transient cardiac standstill by infusing a high concentration of potassium allows successful cardioversion of VF during cardiopulmonary bypass . In a study that included 8,456 adult patients undergoing cardiac operations on cardiopulmonary bypass, Almdahl et al . reported that 79% of patients with VF after aortic declamping were successfully treated with 20 mmol potassium infusion.…”

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confidence: 99%

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Effects of Potassium/Lidocaine-induced Cardiac Standstill During Cardiopulmonary Resuscitation in a Pig Model of Prolonged Ventricular Fibrillation

Lee

Jeung

et al. 2014

Acad Emerg Med

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Objectives: Several studies in patients who underwent open heart surgery found that myocardial ischemic damage was reduced by potassium cardioplegia combined with lidocaine infusion. The authors evaluated the effects of potassium/lidocaine-induced cardiac standstill during conventional cardiopulmonary resuscitation (CPR) on myocardial injury and left ventricular dysfunction after resuscitation from prolonged ventricular fibrillation (VF) cardiac arrest in a pig model. Methods: Ventricular fibrillation was induced in 16 pigs, and circulatory arrest was maintained for 14 minutes. Animals were then resuscitated by standard CPR. Animals were randomized at the start of CPR to receive 20 mL of saline (control group) or 0.9 mEq/kg potassium chloride and 1.2 mg/kg lidocaine diluted to 20 mL (K-lido group). Results: Seven animals in each group achieved return of spontaneous circulation (ROSC; p = 1.000). Four of the K-lido group animals (50%) achieved ROSC without countershock. Resuscitated animals in the K-lido group required fewer countershocks (p = 0.004), smaller doses of epinephrine (p = 0.009), and shorter durations of CPR (p = 0.004) than did the control group. The uncorrected troponin-I at 4 hours after ROSC was lower in the K-lido group compared with the control group (2.82 ng/mL, 95% confidence interval [CI] = 1.07 to 3.38 ng/mL vs. 6.55 ng/mL, 95% CI = 4.84 to 13.30 ng/mL; p = 0.025), although the difference was not significant after Bonferroni correction. The magnitude of reduction in left ventricular ejection fraction (LVEF) between baseline and 1 hour after ROSC was significantly lower in the K-lido group (26.5%, SD AE 6.1% vs. 39.1%, SD AE 6.8%; p = 0.004). Conclusions: In a pig model of untreated VF cardiac arrest for 14 minutes, resuscitation with potassium/ lidocaine-induced cardiac standstill during conventional CPR tended to reduce myocardial injury and decreased the severity of postresuscitation myocardial dysfunction significantly. ACADEMIC EMERGENCY MEDICINE 2014;21:392-400 V entricular fibrillation (VF) greatly increases myocardial energy demands relative to energy supply because the fibrillating heart continues to consume energy. 1,2 Coronary perfusion generated during conventional cardiopulmonary resuscitation (CPR) rarely exceeds 30% of normal and thus fails to meet the

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Effects of Potassium/Lidocaine-induced Cardiac Standstill During Cardiopulmonary Resuscitation in a Pig Model of Prolonged Ventricular Fibrillation

Lee

Jeung

et al. 2014

Acad Emerg Med

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“…The mechanism of ventricular fibrillation appearing at that time is not precisely understood. It is well known that many factors contribute, such as electrolyte and acid disturbances or gradients, conduction abnormalities and more importantly inadequate myocardial preservation may play a role [3]. The best method must be developed for protection of the heart from myocardial injury during open heart surgery [4].…”

Section: Discussionmentioning

confidence: 99%

“…The stabilizing effect of potassium on ventricular fibrillation after declamping of the aorta has been much studied previously [15]. Sven M. Almdahl et al demonstrated that potassium infusion is an effective and convenient first-hand measure to convert post declamping VF on CPB [3]. Marcus L Koller et al, in an experimental model, demonstrated the anti-fibrillatory effect of hyperkalaemia on sustained VF.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Plegisol and Modified ST Thomas Hospital Cardioplegic Solution in the Development of Ventricular Fibrillation after Declamping of the Aorta

Aldemir¹,

Karatepe²,

Bakı³

et al. 2014

WJCS

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Ventricular fibrillation seen just after declamping of the aorta is an undesirable condition causing myocardial injury. To return to normal rhythm, often internal shocks are applied. But defibrillation itself can also contribute to myocardial injury. So prevention of fibrillation is more important than treatment. 236 patients undergoing coronary artery by-pass surgery were included in this retrospective clinical study. 144 of those patients were operated using modified St. Thomas' Hospital cardioplegic solution, for stopping the heart. In the other 92 patients, plegisol cardioplegic solution was used. We compared the two groups for the development of ventricular fibrilation after declamping of the aorta. In the modified St. Thomas' Hospital group, ventricular fibrillation after declamping of the aorta was seen less frequently, this being statistically significant (22.2% vs. 52.2%, p = 0.026). This study shows that the modified St.Thomas' Hospital cardioplegic solution is preferred for avoiding ventricular fibrillation occuring just after declamping of the aorta.

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“…4 Multiple investigators have studied extended potassium cardioplegia combined with cardiopulmonary bypass to treat or reverse refractory arrest and associated ischemia after cardiac surgery. 5-8 Treatment with combined cardiopulmonary bypass and potassium cardioplegia has also been studied for induced VF without surgery. 9 Provision of cardiopulmonary bypass during the treatment of spontaneous cardiac arrest is feasible, but challenging.…”

Section: Introductionmentioning

confidence: 99%

Energy conserving chemical defibrillation of ventricular fibrillation: A randomized two phase controlled blinded trial

et al. 2016

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Objectives Potassium cardioplegia-induced transient asystole may conserve myocardial energy, foster chemical defribrillation, and improve VF arrest outcome. A trial of potassium infusion with or without calcium reversal was conducted to test for improvement in intra-arrest VF waveform and post-ROSC hemodynamics. Methods Eighteen swine were randomized to three treatment arms in two phases. VF was electrically induced and untreated for four minutes. The animals then received six minutes of mechanical CPR. Blinded investigators infused two study medicines peripherally during this interval. One group received 1.5 mEq/kg KCl with CPR initiation followed three minutes later by CaCl 10% infusion 0.12 cc/kg, the second group received 1.5 mEq/kg KCl without CaCl, and the third group received placebo infusions. Ten minutes post VF initiation, defibrillation was performed, as appropriate, followed by ACLS for continued arrest or observation for 30 minutes if ROSC. AMSA change from before to 5 minutes post study drug infusion was compared with nonparametric statistics. MAP post ROSC was compared using mixed linear regression analysis. Results Average normalized AMSA change was −0.15, −.63, and +0.27 in the KCl, KCl+CaCl, and placebo groups, respectively(p=0.01). Three KCl+CaCl animals developed on organized rhythm chemically without electrical defibrillation. One, 3, and 4 animals in the KCl, KCl+CaCl, and placebo groups, respectively, survived post ROSC. Post ROSC, MAP decreased 1.8 mm Hg (95% CI −1.4to5.1) per minute less in the KCl+CaCl group compared to placebo. Conclusions Chemical defibrillation and ROSC are possible post potassium-induced asystole. Potassium followed by calcium reversal, but not potassium alone, led to ROSC and post-ROSC hemodynamics comparable to recommended therapy.

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Potassium-induced conversion of ventricular fibrillation after aortic declamping

Abstract: The results from this register study demonstrate that potassium infusion is an effective and convenient first-hand measure to convert post declamping VF on CPB.

Cited by 12 publications

References 25 publications

Effects of Potassium/Lidocaine-induced Cardiac Standstill During Cardiopulmonary Resuscitation in a Pig Model of Prolonged Ventricular Fibrillation

Effects of Potassium/Lidocaine-induced Cardiac Standstill During Cardiopulmonary Resuscitation in a Pig Model of Prolonged Ventricular Fibrillation

Comparison of Plegisol and Modified ST Thomas Hospital Cardioplegic Solution in the Development of Ventricular Fibrillation after Declamping of the Aorta

Energy conserving chemical defibrillation of ventricular fibrillation: A randomized two phase controlled blinded trial

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