Massive transfusion and hyperkalaemic cardiac arrest in craniofacial surgery in a child

Area of Science:

• Cardiology
• Pediatric Surgery
• Transfusion Medicine

Background:

• Hyperkalaemia is a known complication associated with massive blood transfusions.
• Massive transfusions are sometimes necessary in complex pediatric surgical procedures.

Observation:

• A 12-month-old infant undergoing craniofacial surgery for sagittal craniosynostosis experienced hyperkalemic cardiac arrest.
• The arrest occurred after a two-hour period involving a massive transfusion of predominantly irradiated packed red blood cells.
• The patient's plasma potassium concentration was measured at 10.1 mmol/l at the time of cardiac arrest.

Findings:

• The case highlights a critical risk of hyperkalaemia during massive transfusions in pediatric patients.
• Successful cardiopulmonary resuscitation was achieved after 15 minutes.

Implications:

• The study recommends using fresh, non-irradiated packed red blood cells in pediatric surgery whenever feasible.
• This recommendation aims to mitigate the risk of hyperkalaemia and associated cardiac complications.
• Further research into transfusion practices in pediatric surgery is warranted.