Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 2.1 (5-Year IF – 2.0)
Journal Citation Indicator (JCI) (2023) – 0.4
Scopus CiteScore – 3.7 (CiteScore Tracker – 4.0)
Index Copernicus  – 171.00; MNiSW – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2020, vol. 29, nr 6, June, p. 727–734

doi: 10.17219/acem/122178

Publication type: original article

Language: English

License: Creative Commons Attribution 3.0 Unported (CC BY 3.0)

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Relationship between serum potassium level and survival outcome in out-of-hospital cardiac arrest using CAPTURES database of Korea: Does hypokalemia have good neurological outcomes in out-of-hospital cardiac arrest?

Dong Sun Choi1,A,B,C,D,F, Sang Do Shin1,A,C,E,F, Young Sun Ro2,B,C,E,F, Kyung Won Lee3,D,E,F

1 Department of Emergency Medicine, Seoul National University Hospital, South Korea

2 Biomedical Research Institute, Seoul National University Hospital, South Korea

3 Department of Emergency Medicine, Kyung Hee University Hospital at Gangdong, South Korea

Abstract

Background. Sudden cardiac arrest is a major cause of death worldwide. Serum potassium level is an initial laboratory test that serves as part of an electrolyte panel easily obtainable by most emergency departments (EDs).
Objectives. To evaluate the relationship between serum potassium level and the survival outcome for out-of-hospital cardiac arrest (OHCA) patients.
Material and Methods. We used the Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiological Surveillance (CAPTURES) database, which made up the OHCA cohort of 27 EDs in Korea from January to December 2014. The inclusion criteria were all OHCA patients in the cohort who had received cardiopulmonary resuscitation (CPR) in the hospital. The patients were excluded if they were transferred from another hospital, had a pre-hospital return of spontaneous circulation (ROSC), or if the potassium level and clinical outcome data were missing or not captured. The main parameter was serum potassium level on ED arrival. According to the serum potassium level, the patients were divided into a hypokalemia group (K+ < 3.5 mEq/L), a normokalemia group (K+ = 3.5–5.4 mEq/L) and a hyperkalemia group (K+ ≥ 5.5 mEq/L). The primary outcome was neurologically favorable survival discharge.
Results. Among the 1,616 patients in the CAPTURES cohort, 913 patients were included in the analysis, of whom 46 patients (5.9%) were assigned to the hypokalemia group, 370 patients (40.5%) were assigned to the normokalemia group and 497 patients (54.4%) were assigned to the hyperkalemia group. The hypokalemia group has a significantly higher percentage of good neurological outcomes (26.1%). There was a significant positive correlation with neurologically favorable survival (odds ratio (OR) = 4.45; 95% confidence interval (95% CI) = 1.67–11.91) and a significant positive correlation with survival discharge (OR = 2.25; 95% CI = 1.05–4.82).
Conclusion. In OHCA patients, serum potassium level measured in the hospital showed a significant association with survival outcome. Hypokalemia had a significant association with good neurological outcome and survival discharge.

Key words

potassium, hypokalemia, resuscitation, sudden cardiac death, hyperkalemia

References (29)

  1. Berdowski J, Berg RA, Tijssen JG, Koster RW. Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies. Resuscitation. 2010;81(11):1479–1487.
  2. Mozaffarian D, Benjamin EJ, Go AS, et al; American Heart Association Statistics Committee; Stroke Statistics Subcommittee. Heart disease and stroke statistics – 2015 update: A report from the American Heart Association. Circulation. 2015;131(4):e29–e322.
  3. Iwami T, Nichol G, Hiraide A, et al. Continuous improvements in “Chain of Survival” increased survival after out-of-hospital cardiac arrests: A large-scale population-based study. Circulation. 2009;119(5):728–734.
  4. Ahn KO, Do Shin S, Suh GJ, et al. Epidemiology and outcomes from non-traumatic out-of-hospital cardiac arrest in Korea: A nationwide observational study. Resuscitation. 2010;81(8):974–981.
  5. Eisenberg MS, Cummins RO, Larsen MP. Numerators, denominators, and survival rates: Reporting survival from out-of-hospital cardiac arrest. Am J Emerg Med. 1991;9(6):544–546.
  6. Pepe PE, Levine RL, Fromm RE Jr, Curka PA, Clark PS, Zachariah BS. Cardiac arrest presenting with rhythms other than ventricular fibrillation: Contribution of resuscitative efforts toward total survivorship. Crit Care Med. 1993;21(12):1838–1843.
  7. Weston CF, Wilson RJ, Jones SD. Predicting survival from out-of-hospital cardiac arrest: A multivariate analysis. Resuscitation. 1997;34(1):27–34.
  8. Böttiger BW, Möbes S, Glätzer R, et al. Astroglial protein S-100 is an early and sensitive marker of hypoxic brain damage and outcome after cardiac arrest in humans. Circulation. 2001;103(22):2694–2698.
  9. Fogel W, Krieger D, Veith M, et al. Serum neuron-specific enolase as early predictor of outcome after cardiac arrest. Crit Care Med. 1997;25(7):1133–1138.
  10. Callaway CW, Donnino MW, Fink EL, et al. Part 8: Post–Cardiac Arrest Care 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S465–S482.
  11. Cohen JG, Boue Y, Boussat B, et al. Serum potassium concentration predicts brain hypoxia on computed tomography after avalanche-induced cardiac arrest. Am J Emerg Med. 2016;34(5):856–860.
  12. Su Y-J, Lai Y-C. Optimal parameters for return of spontaneous circulation in resuscitating out-of-hospital cardiac arrest patients. Int J Gerontol. 2009;3(2):96–100.
  13. Choi JS, Kim YA, Kim HY, et al. Relation of serum potassium level to long-term outcomes in patients with acute myocardial infarction. Am J Cardiol. 2014;113(8):1285–1290.
  14. Patel RB, Tannenbaum S, Viana-Tejedor A, et al. Serum potassium levels, cardiac arrhythmias, and mortality following non-ST-elevation myocardial infarction or unstable angina: Insights from MERLIN-TIMI 36. Eur Heart J Acute Cardiovasc Care. 2017:6(1):18–25.
  15. Ro YS, Shin SD, Song KJ, et al; Cardiac Arrest Pursuit Trial with Unique Registry and Epidemiologic Surveillance (CAPTURES) investigators. Risk of diabetes mellitus on incidence of out-of-hospital cardiac arrests: A case-control study. PLoS One. 2016;11(4):e0154245.
  16. Ro YS, Shin SD, Song KJ, et al. Interaction effects between hypothermia and diabetes mellitus on survival outcomes after out-of-hospital cardiac arrest. Resuscitation. 2015;90:35–41.
  17. Kim MJ, Ro YS, Shin SD, et al. Association of emergent and elective percutaneous coronary intervention with neurological outcome and survival after out-of-hospital cardiac arrest in patients with and without a history of heart disease. Resuscitation. 2015;97:115–121.
  18. Neumar RW, Otto CW, Link MS, et al. Part 8: Adult advanced cardiovascular life support. Circulation. 2010;122(18 Suppl 3):S729–S767.
  19. Jacobs I, Nadkarni V, Bahr J, et al; International Liaison Committee on Resuscitation; American Heart Association; European Resuscitation Council; Australian Resuscitation Council; New Zealand Resuscitation Council; Heart and Stroke Foundation of Canada; InterAmerican Heart Foundation; Resuscitation Councils of Southern Africa; ILCOR Task Force on Cardiac Arrest and Cardiopulmonary Resuscitation Outcomes. Cardiac arrest and cardiopulmonary resuscitation outcome reports: Update and simplification of the Utstein templates for resuscitation registries. A statement for healthcare professionals from a task force of the international liaison committee on resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa). Resuscitation. 2004;63(3):233–249.
  20. An JN, Lee JP, Jeon HJ, et al. Severe hyperkalemia requiring hospitalization: Predictors of mortality. Crit Care. 2012;16(6):R225.
  21. Lin C-H, Tu Y-F, Chiang W-C, Wu S-Y, Chang Y-H, Chi C-H. Electrolyte abnormalities and laboratory findings in patients with out-of-hospital cardiac arrest who have kidney disease. Am J Emerg Med. 2013;31(3):487–493.
  22. Wissenberg M, Folke F, Hansen CM, et al. Survival after out-of-hospital cardiac arrest in relation to age and early identification of patients with minimal chance of long-term survival. Circulation. 2015:131(18):1536–1545.
  23. Ettinger PO, Regan TJ, Oldewurtel HA, Khan MI. Ventricular conduction delay and asystole during systemic hyperkalemia. Am J Cardiol. 1974;33(7):876–886.
  24. Niemann JT, Cairns CB. Hyperkalemia and ionized hypocalcemia during cardiac arrest and resuscitation: Possible culprits for postcounter­shock arrhythmias? Ann Emerg Med. 1999;34(1):1–7.
  25. Swor RA, Jackson RE, Tintinalli JE, Pirallo RG. Does advanced age matter in outcomes after out-of-hospital cardiac arrest in community-dwelling adults? Academic Emerg Med. 2000;7(7):762–768.
  26. Sasson C, Rogers MA, Dahl J, Kellerman RL. Predictors of survival from out-of-hospital cardiac arrest: A systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2010;3(1):63–81.
  27. Kjeldsen K. Hypokalemia and sudden cardiac death. Exp Clin Cardiol. 2010;15(4):e96–e99.
  28. Alharbi FF, Souverein PC, de Groot MCH, et al. The impact of serum potassium-influencing antihypertensive drugs on the risk of out-of-hospital cardiac arrest: A case-control study. Br J Clin Pharmacol. 2017;83(11):2541–2548.
  29. Litwin PE, Eisenberg MS, Hallstrom AP, Cummins RO. The location of collapse and its effect on survival from cardiac arrest. Ann Emerg Med. 1987;16(7):787–791.
© Wroclaw Medical University