Pharmacologic Interventions for Severe Hyperkalemia with Cardiac Arrest
Red Cross Guidelines
- For children in cardiac arrest associated with hyperkalemia, treatment should be directed at the immediate reduction in serum potassium levels, concurrent with resuscitation efforts. (Good practice statement) NEW
- Intravenous (if available) or inhaled bronchodilators (salbutamol or albuterol) or insulin with glucose, or a combination of both, may be used to lower the potassium levels in pediatric patients with cardiac arrest associated with hyperkalemia, concurrent with ongoing high-quality resuscitation efforts.
- Evidence supporting the use of sodium bicarbonate and/or calcium in cardiac arrest associated with hyperkalemia is limited and of uncertain benefit. While not routinely recommended, they may be considered during resuscitation of cardiac arrest in special circumstances (e.g., cocaine and other sodium channel blocker toxicity with life-threatening arrhythmias).
Insights
Severe hyperkalemia can lead to arrhythmias and cardiac arrest. Studies in acutely hyperkalemic neonates and children demonstrate significant decreases in potassium levels with both intravenous and inhaled beta-2 agonist administration and with intravenous insulin plus glucose. Calcium administration has been recommended in the past for severe hyperkalemia to stabilize the myocardial membrane. However, observational studies of infants and children in undifferentiated cardiac arrest report calcium and sodium bicarbonate administration to be associated with lower rates of both survival to hospital discharge and survival with favorable neurologic outcome at hospital discharge. No differences in outcomes were seen for hyperkalemic children in cardiac arrest who were treated with calcium, although the number of hyperkalemic children with cardiac arrest was small.