The problem of cardiac collapse associated with he massive transfusion of citrated blood

Gain, E. A.

doi:10.1007/bf03023861

Cited by 8 publications

(2 citation statements)

References 9 publications

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“…The fact that transfusion with citrated blood might lower [iCa] to symptomatic levels was recognized before World War I, 18,19 and concerns about this effect reemerge periodically as transfusion patterns and products change. 4,20–22 Recognition that hypocalcemia is common in severe illness 1,23,24 and injury 2,3,25 is more recent. In our study, most patients had hypocalcemia during the first 3 hours of treatment for major trauma, and more than half received early calcium replacement.…”

Section: Discussionmentioning

confidence: 99%

Association Between Ionized Calcium Concentrations During Hemostatic Transfusion and Calcium Treatment With Mortality in Major Trauma

Chanthima

Yuwapattanawong

Thamjamrassri

et al. 2021

Anesthesia &Amp; Analgesia

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BACKGROUND: Transfusion of citrated blood products may worsen resuscitation-induced hypocalcemia and trauma outcomes, suggesting the need for protocolized early calcium replacement in major trauma. However, the dynamics of ionized calcium during hemostatic resuscitation of severe injury are not well studied. We determined the frequency of hypocalcemia and quantified the association between the first measured ionized calcium concentration [iCa] and calcium administration early during hemostatic resuscitation and in-hospital mortality. METHODS: We performed a retrospective cohort study of all admissions to our regional level 1 trauma center who (1) were ≥15 years old; (2) presented from scene of injury; (3) were admitted between October 2016 and September 2018; and (4) had a Massive Transfusion Protocol activation. They also (1) received blood products during transport or during the first 3 hours of in-hospital care (1st3h) of trauma center care and (2) had at least one [iCa] recorded in that time. Demographic, injury severity, admission shock and laboratory data, blood product use and timing, and in-hospital mortality were extracted from Trauma Registry and Transfusion Service databases and electronic medical records. Citrate load was calculated on a unit-by-unit basis and used to calculate an administered calcium/citrate molar ratio. Univariate and multivariable logistic regression analyses for the binary outcome of in-hospital death were performed. RESULTS: A total of 11,474 trauma patients were admitted to the emergency department over the study period, of whom 346 (3%; average age: 44 ± 18 years; 75% men) met all study criteria. In total, 288 (83.2%) had hypocalcemia at first [iCa] determination; 296 (85.6%) had hypocalcemia in the last determination in the 1st3h; and 177 (51.2%) received at least 1 calcium replacement dose during that time. Crude risk factors for in-hospital death included age, injury severity score (ISS), new ISS (NISS), Abbreviated Injury Scale (AIS) head, admission systolic blood pressure (SBP), pH, and lactate; all P < .001. Higher in-hospital mortality was significantly associated with older age, higher NISS, AIS head, and admission lactate, and lower admission SBP and pH. There was no relationship between mortality and first [iCa] or calcium dose corrected for citrate load. CONCLUSIONS: In our study, though most patients had hypocalcemia during the 1st3h of trauma center care, neither first [iCa] nor administered calcium dose corrected for citrate load were significantly associated with in-patient mortality. Clinically, hypocalcemia during early hemostatic resuscitation after severe injury is important, but specific treatment protocols must await better understanding of calcium physiology in acute injury.

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Section: Discussionmentioning

confidence: 99%

Association Between Ionized Calcium Concentrations During Hemostatic Transfusion and Calcium Treatment With Mortality in Major Trauma

Chanthima

Yuwapattanawong

Thamjamrassri

et al. 2021

Anesthesia &Amp; Analgesia

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“…Between 6 and 10 mg/100 ml the correlation of Ca 2 and dP/dt is nonlinear because of "plateauing" of the concentration-response curves. At Ca 2 concentrations greater than 10 mg/100 ml dP/dt tended to decrease with increasing Ca 2 , and the r value changes sign to negative. Serum Na and K, total Ca, and total Mg were measured at the beginning of each concentration-response curve (EC 0 ), near the EC 50 , and at maximum (EC 100 )-These results appear in Table 2.…”

Section: Methodsmentioning

confidence: 99%

Ionized calcium and the heart. Elucidation of in vivo concentration-response relationships in the open-chest dog.

Bristow¹,

Schwartz²,

Binetti³

et al. 1977

Circulation Research

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SUMMARY Pharmacological relationships between ionized calcium and cardiac electric and mechanical parameters were explored in the open-chest dog. A technique that allows the determination of reliable, repeatable concentration-response relationships in vivo was developed. This method consists of alternating infusions of sodium citrate and calcium gluconate and direct measurement of serum ionized calcium by an ion-specific electrode. With this technique, four consecutive curves for ionized calcium vs. the first derivative of the left ventricular pressure (dP/dt) were essentially superimposable within the limits of 2-10 mg/100 ml. Relationships between ionized calcium and the electrocardiograph (ECG) interval measured from the end of the S wave to the peak of the T wave (S a T c ) proved to be superior to other ECG measurements as a correlate of ionized calcium. Ionized calcium correlated better than total calcium with physiological function in several situations. Postsurgical ionized calcium levels (4.92 ± 0.10 mg/100 ml) were consistently higher than preanesthetic values (4.57 ± 0.07 mg/100 ml, P < 0.025), whereas total calcium measurements were not significantly different (X = 5.3 ± 0.10 mEq/liter, X = 5.1 ± 0.10 mEq/liter, P < 0.1). This difference in ionized calcium was shown to be able to account for significant alterations in dP/dt, suggesting that fluctuations in ionized calcium may be involved in the regulation of the contractile state of the heart. VARIATIONS in the extracellular concentration of ionized calcium (Ca 2+ ) have important effects on the electrical and mechanical function of the intact mammalian heart. In man, hypocalcemia associated with rapid transfusion of citrated blood has been implicated as a cause of decreased contractility, cardiovascular collapse, and cardiac arrest.1 " 4 Hypercalcemia has been associated with an increase in contractility in animals, 5 " 7 and conduction disturbances, ventricular irritability, and cardiac arrest have been.described in man. 8 " 10 Recent studies have shown that the fraction of myocardial calcium that is correlated with contractility is readily exchangeable and in rapid equilibrium with plasma Ca 2 " 1 ". 11- 12 Since it has been suggested that alterations in cellular calcium levels are a common mediator of a variety of pharmacological influences on the contractile state of the heart, 13 it is possible that minor as well as major changes in the extracellular Ca 2+ can have important effects on cardiac function.Because to determine quantitative relationships in vivo between Ca 2+ and myocardial response throughout a wide range of serum Ca 2+ . MethodsTwenty-two mongrel dogs weighing 14-30 kg were sedated with morphine sulfate (2 mg/kg) intramuscularly, then anesthetized with intravenous chloralose and urethane at doses of 85 mg/kg and 625 mg/kg, respectively. Ventilation was provided by a Harvard pump delivering room air through a cuffed endotracheal tube. Arterial blood gases were monitored frequently with a Corning model 165 gas analyzer and pH w...

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Allgemeiner Teil

Stucke¹,

Viehweger²,

Hockerts³

et al. 1965

Traumatologie in Der Chirurgischen Praxis

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The problem of cardiac collapse associated with he massive transfusion of citrated blood

Cited by 8 publications

References 9 publications

Association Between Ionized Calcium Concentrations During Hemostatic Transfusion and Calcium Treatment With Mortality in Major Trauma

Association Between Ionized Calcium Concentrations During Hemostatic Transfusion and Calcium Treatment With Mortality in Major Trauma

Ionized calcium and the heart. Elucidation of in vivo concentration-response relationships in the open-chest dog.

Allgemeiner Teil

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