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Treatment of Presumed Hyperkalemia in the Prehospital Setting
Robert McArthur1, Zubaid Rafique1, Brad Ward2
1Baylor College of Medicine, Department of Emergency Medicine, Houston, TexasUSA.
Insights
Prehospital treatment for hyperkalemia (HK) is feasible for emergency medical services (EMS). This novel protocol effectively identified and managed presumed HK, with no adverse events during transport.
Area of Science:
- Emergency Medicine
- Cardiology
- Clinical Research
Background:
- Hyperkalemia (HK) is a common, life-threatening condition that can lead to ventricular arrhythmia and cardiac arrest if untreated.
- Early intervention for HK significantly reduces mortality rates.
Purpose of the Study:
- To evaluate a novel protocol for the identification and empiric management of presumed hyperkalemia in the prehospital setting.
- To assess the feasibility and safety of this protocol for Emergency Medical Services (EMS) crews.
Main Methods:
- Retrospective observational chart review of patients treated for presumed HK with clinical concern and ECG changes.
- Inclusion criteria: patients treated for presumed HK with ECG changes, excluding those in cardiac arrest on arrival.
- Empiric treatment included calcium, sodium bicarbonate, and albuterol; adverse events and serum potassium levels were recorded.
Main Results:
- 48 patients were included in the analysis; 45.8% had serum potassium >5.0 mEq/L.
- 89.6% of cases showed hyperkalemia-related ECG changes.
- No episodes of unstable tachyarrhythmia or cardiac arrest occurred during EMS treatment or transport.
Conclusions:
- The novel prehospital protocol for identifying and managing presumed HK is feasible for EMS crews.
- Further research with a larger study population is necessary to generalize these findings.
Introduction:
Hyperkalemia (HK) is common and potentially a life-threatening condition. If untreated, HK can progress to ventricular arrhythmia and cardiac arrest. Early treatment reduces mortality in HK. This study evaluates a novel protocol for identification and empiric management of presumed HK in the prehospital setting.
Methods:
This was a retrospective, observational chart review of a single, large, suburban Emergency Medical Services (EMS) system. Patients treated for presumed HK, with both a clinical concern for HK and electrocardiogram (ECG) changes consistent with HK, from February 2018 through February 2021 were eligible for inclusion. Patients were excluded if found to be in cardiac arrest on EMS arrival. Empiric treatment of HK included administration of calcium, sodium bicarbonate, and albuterol. Post-treatment, patients were placed on cardiac monitoring and adverse events recorded enroute to receiving hospital. Protocol compliance was assessed by two independent reviewers. Serum potassium (K) level was obtained from hospital medical records.
Results:
A total of 582 patients were treated for HK, of which 533 patients were excluded due to cardiac arrest prior to EMS arrival. The remaining 48 patients included in the analysis had a mean age of 56 (SD = 20) years and were 60.4% (n = 29) male with 77.1% (n = 37) Caucasian, 10.4% (n = 5) African American, and 12.5% (n = 6) Hispanic. Initial blood draw at the receiving facilities showed K >5.0mEq/L in 22 (45.8%), K of 3.5-5.0mEq/L in 23 (47.9%), and K <3.5mEq/L in three patients (6.3%). Independent review of the EMS ECG found the presence of hyperkalemic-related change in 43 (89.6%) cases, and five (10.4%) patients did not meet criteria for treatment due to lack of either appropriate ECG findings or clinical suspicion. No episodes of unstable tachyarrhythmia or cardiac arrest occurred during EMS treatment or transport.
Conclusion:
The study evaluated a novel protocol for detecting and managing HK in the prehospital setting. It is feasible for EMS crews to administer this protocol, although a larger study is needed to make the results generalizable.
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