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Treatment of Presumed Hyperkalemia in the Prehospital Setting

Published online by Cambridge University Press:  04 August 2022

Robert McArthur Open the ORCID record for Robert McArthur [Opens in a new window] ,
Zubaid Rafique ,
Brad Ward ,
Luis Rodriguez ,
Robert Dickson  and
Casey Patrick Open the ORCID record for Casey Patrick [Opens in a new window]
Robert McArthur*
Affiliation:
Baylor College of Medicine, Department of Emergency Medicine, Houston, TexasUSA
Zubaid Rafique
Affiliation:
Baylor College of Medicine, Department of Emergency Medicine, Houston, TexasUSA
Brad Ward
Affiliation:
Montgomery County Hospital District EMS, Conroe, TexasUSA
Luis Rodriguez
Affiliation:
Baylor College of Medicine, Department of Emergency Medicine, Houston, TexasUSA
Robert Dickson
Affiliation:
Baylor College of Medicine, Department of Emergency Medicine, Houston, TexasUSA Montgomery County Hospital District EMS, Conroe, TexasUSA
Casey Patrick
Affiliation:
Montgomery County Hospital District EMS, Conroe, TexasUSA
*
Correspondence: Robert McArthur, MD Department of Emergency Medicine Baylor College of Medicine 1504 Taub Loop Houston, Texas77030USA E-mail: rdmcarth@bcm.edu
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Abstract

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.

Keywords

Emergency Medical Serviceshyperkalemiaprehospital
Type
Research Report
Information
Prehospital and Disaster Medicine , Volume 37 , Issue 5 , October 2022 , pp. 693 - 697
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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