- Author: Kyeong Ryeol Cheon, Duck Cho, Kyo Seon Lee, Hwa Jin Cho, In Seok Jeong
- Date: 2015/05/31
- Journal: Korean Journal of Critical Care Medicine;30(2);132-134
- PMID:
- PMCID:
- DOI: https://doi.org/10.4266/kjccm.2015.30.2.132
Abstract
Cardiac arrest associated with hyperkalemia during red blood cell transfusion is a rare but fatal complication. Herein, we report a case of transfusion-associated cardiac arrest following the initiation of extracorporeal membrane oxygenation support in a 9-month old infant. Her serum potassium level was increased to 9.0 mEq/L, soon after the newly primed circuit with pre-stored red blood cell (RBC) was started and followed by sudden cardiac arrest. Eventually, circulation was restored and the potassium level decreased to 5.1 mEq/L after 5 min. Extracorporeal membrane oxygenation (ECMO) priming is a relatively massive transfusion into a pediatric patient. Thus, to prevent cardiac arrest during blood-primed ECMO in neonates and infants, freshly irradiated and washed RBCs should be used when priming the ECMO circuit, to minimize the potassium concentration. Also, physicians should be aware of all possible complications associated with transfusions during ECMO.
Keywords: blood transfusion, extracorporeal membrane oxygenation, heart arrest, hyperkalemia
Extracorporeal membrane oxygenation (ECMO) is a well-established treatment for patients with severe cardiopulmonary failure. On ECMO commencement, a large amount of priming liquid from the extracorporeal circuit enters the body, equivalent to a rapid and massive transfusion. Caution is required as this increases the risk of transfusion-associated hyperkalemia and associated cardiac arrest.[1] Moreover, when an infant is undergoing ECMO, the use of irradiated pre-stored packed red blood cell (RBC) to prime ECMO support may increase the risk of transfusion-associated hyperkalemic cardiac arrest (TAHCA). Herein, we report the case of an infant, who experienced sudden cardiac arrest after EMCO initiation.