Hyperkalemia of the blood-primed ECLS circuit does not result in post-initiation hyperkalemia in infants

Abstract

Objective: To assess the risk of hyperkalemia with blood-primed extracorporeal life support (ECLS) circuits in infants < 10 kg.

Design: Retrospective cohort study of all neonatal and pediatric patients <10 kg placed on ECLS from May 1998 to April 2001.

Measurements and main results: Data collection including patient weight, patient potassium levels pre- and post-initiation of ECLS, potassium level of the primed ECLS circuit, age of the packed red blood cell (PRBC) unit, type of preservative, and preservative reduction status. Seventy-six circuits were available for the analysis. The age of the PRBC unit and preservative reduction status significantly affected the potassium level of the primed ECLS circuit. Multivariate linear regression analysis showed no significant effect on the post-ECLS initiation patient potassium level with respect to the PRBC age, the preservative reduction status, the patient potassium level prior to ECLS initiation, and the potassium level of the primed ECLS circuit.

Conclusions: Initiation of ECLS in infants <10 kg should not be delayed unnecessarily to perform preservative reduction or to utilize PRBC units of a specific age, as hyperkalemia of the primed ECLS circuit is not associated with systemic hyperkalemia in the patient post-initiation of ECLS.

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References

Hall TL , Barnes JR , Miller JR et al. Neonatal mortality following transfusion of red cells with high plasma potassium levels . Transfusion 1993; 33: 606-609 .

Brown KA , Bissonnette B , MacDonald M et al. Hyper-kalemia during massive blood transfusion in pediatric craniofacial surgery . Can J Anesth 1990; 37: 401-408 .

Scanlon JW , Krakaur R. Hyperkalemia following exchange transfusion . J Pediatr 1980; 96: 108-110 .

Brophy PD , Mottes TA , Kudelka TL et al. AN-69 membrane reactions are pH-dependent and preventable . Am J Kidney Dis 2001; 38: 173-178 .

Shimpo H , Shimamoto A , Miyake Y et al. Effect of ultrafiltration on priming solution with preserved blood for extracorporeal circulation in infants . ASAIO J 1996; 42: M792-M794 .

Pasko DA , Mottes TA , Mueller BA. Pre dialysis of blood prime in continuous hemodialysis normalizes pH and electrolytes . Pediatr Nephrol 2003; 18: 1177-1183 .

Bailey DN , Bove JR. Chemical and hematological changes in stored CPD blood . Transfusion 1975; 15: 244-249 .

Wallas CH. Sodium and potassium changes in blood bank stored human erythrocytes . Transfusion 1979; 19: 210-215 .

Ratcliffe JM , Elliott MJ , Wyse RKH et al. The metabolic load of stored blood. Implications for major transfusions in infants . Arch Dis Child 1986; 61: 1208-1214 .

10.

Mueller-Steinhardt M , Hennig H , Kirchner H , Schlenke P. Pre-storage WBC filtration of RBC units with soft-shell filters: filtration performance and impact on RBCs during storage for 42 days . Transfusion 2002; 42: 153-158 .

11.

Keidan I , Amir G , Mandel M , Mishali D. The metabolic effects of fresh versus old stored blood in the priming of cardiopulmonary bypass solution for pediatric patients . J Thorac Cardiovasc Surg 2004; 127: 949-952 .

Hyperkalemia of the blood-primed ECLS circuit does not result in post-initiation hyperkalemia in infants < 10 kg

Abstract

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