Serum potassium concentration predicts brain hypoxia on CT after avalanche-induced cardiac arrest
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Fig. 1
Flow chart of the study population.
Fig. 2
Empirical receiving operator curve (ROC, black line) and smooth kernel density ROC curve (dash line) of serum potassium concentration to predict brain hypoxia. Serum potassium concentration was measured at hospital admission on a central line. Brain hypoxia was defined by experienced neuroradiologist as isolated brain edema, loss of white/gray matter differentiation and/or hypodensity of basal ganglia.
Abstract
Background
Brain anoxia after complete avalanche burial and cardiac arrest (CA) may occur despite adequate on-site triage.
Purpose
To investigate clinical and biological parameters associated with brain hypoxia in a cohort of avalanche victims with whole body computed tomographic (CT) scan.
Methods
Retrospective study of patients with CA and whole body CT scan following complete avalanche burial admitted in a level-I trauma center.
Main findings
Out of 19 buried patients with whole body CT scan, eight patients had refractory CA and 11 patients had pre-hospital return of spontaneous circulation. Six patients survived at hospital discharge and only two had good neurologic outcome. Twelve patients had signs of brain hypoxia on initial CT scan, defined as brain edema, loss of gray/white matter differentiation and/or hypodensity of basal ganglia. No clinical pre-hospital parameter was associated with brain anoxia. Serum potassium concentration at admission was higher in patients with brain anoxia as compared to patients with normal CT scan: 5.5 (4.1–7.2) mmol/L versus 3.3 (3.0–4.2) mmol/L, respectively (P < .01). A threshold of 4.35 mmol/L serum potassium had 100% specificity to predict brain anoxia on brain CT scan.
Conclusions
Serum potassium concentration had good predictive value for brain anoxia after complete avalanche burial. This finding further supports the use of serum potassium concentration for extracorporeal life support insertion at hospital admission in this context.
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