Portal de Periódicos da CAPES

Cardiac arrest by hyperkalemia—Fast diagnosis and therapeutics as predictors of good outcome

2010; Elsevier BV; Volume: 81; Issue: 2 Linguagem: Inglês

10.1016/j.resuscitation.2010.09.330

1873-1570

Patrícia Freitas, Sofía Duque, Monica Pinto, Maria Cristina Costa, Maria João Correia, Andrey Sousa, André Carvalho, Vítor Batalha, Luís Campos,

Cardiac electrophysiology and arrhythmias

Introduction: Cardiac arrest (CA) by hyperkalemia is usually fatal. Its correction is mandatory for return of spontaneous circulation (ROSC). The authors describe a case of prolonged CA that after reversal of hyperkalemia with aggressive pharmacological and electrical therapies, evolved without neurological consequences. Case report: 78-year-old female patient, diabetic, hypertensive and asthmatic, victim of CA in asystole at home witnessed by an advanced cardiac life support (ACLS) team. ALS manoeuvres were immediately initiated, maintaining asystole in all cycles. At the 25th minute there was ROSC in 3rd degree atrio-ventricular block and an external pacemaker (EPM) was applied. The patient arrived at the emergency department in Score 3 of Glasgow Coma Scale, with mydriatic and nonreactive pupils and totally dependent on EPM at 80 mA and mechanical ventilation. The echocardiogram did not suggest reasons for CA and showed good left ventricular systolic function in extrinsic electrical stimulation. Laboratory values showed metabolic acidemia and severe hyperkalemia (7.0 mmol/L), from which pharmacological correction was started. After 30 min, there was neurological recovery, respiratory stimuli and intrinsic spontaneous electrical activity, allowing EPM to be withdrawn. Clinical evolution was positive in the first 24 h allowing extubation and recovery with good cerebral performance. Discussion: The authors discuss the intra-CA and post-resuscitation care in the existence of reversible causes, importance of rapid diagnostic methods, prognosis and predictors of outcome.