Intra-patient potassium variability after hypothermic cardiac arrest: a multicentre, prospective study

Abstract

Background: To date, the decision to set up therapeutic extra-corporeal life support (ECLS) in hypothermia-related cardiac arrest is based on the potassium value only. However, no information is available about how the analysis should be performed. Our goal was to compare intra-individual variation in serum potassium values depending on the sampling site and analytical technique in hypothermia-related cardiac arrests.

Methods: Adult patients with suspected hypothermia-related refractory cardiac arrest, admitted to three hospitals with ECLS facilities were included. Blood samples were obtained from the femoral vein, a peripheral vein and the femoral artery. Serum potassium was analysed using blood gas (BGA) and clinical laboratory analysis (CL).

Results: Of the 15 consecutive patients included, 12 met the principal criteria, and 5 (33%) survived. The difference in average potassium values between sites or analytical method used was ≤1 mmol/L. The agreement between potassium values according to the three different sampling sites was poor. The ranges of the differences in potassium using BGA measurement were - 1.6 to + 1.7 mmol/L; - 1.18 to + 2.7 mmol/L and - 0.87 to + 2 mmol/L when comparing respectively central venous and peripheral venous, central venous and arterial, and peripheral venous and arterial potassium.

Conclusions: We found important and clinically relevant variability in potassium values between sampling sites. Clinical decisions should not rely on one biological indicator. However, according to our results, the site of lowest potassium, and therefore the preferred site for a single potassium sampling is central venous blood. The use of multivariable prediction tools may help to mitigate the risks inherent in the limits of potassium measurement.

Trial registration: ClinicalTrials.gov Identifier: NCT03096561.

Keywords: Cardiac arrest; ECMO; ECPR; Gasometer analyser, hypothermia, accidental; Potassium; Resuscitation; Triage.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1

Flow chart of study patients

Fig. 2

Bland-Altman analysis of the difference in potassium between the three sampling sites when analysed by blood gas analyser. For each comparison, the mean value between the two sites is plotted against their difference. Red dash lines represent the ±0.5 mmol/L upper and lower limits of standard criteria for acceptable performance for potassium. CV = central vein; FA = femoral artery; K + =potassium; PV = peripheral vein

Fig. 3

Bland-Altman analysis of the difference in potassium between the two analytic methods for each of the three sampling sites. For each comparison the mean value of potassium for each of the two analytic methods (blood gas analyser or central labolatory) is plotted against their difference. Red dash lines represent the ±0.5 mmol/L upper and lower limits of standard criteria for acceptable performance for potassium. The mean difference in potassium obtained from the central vein between the blood gas analyser and central labolatory was 0.81 (p = 0.0208). The mean difference in potassium obtained from the peripheral vein between the blood gas analyser and central labolatory was 0.51 (p = 0.1491). The mean difference in potassium obtained from the artery between the blood gas analyser and central labolatory was 0.17 (p = 0.5042). BGA = blood gas analyser; CL = central laboratory (CL); K + =potassium