• Mark Andreas Eggertsen, Munch JohannsenCecilieCDepartment of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.Department of Clinical Medicine, Aarhus University, Aarhus, Denmark., Alexander Kovacevic, Fink VallentinMikaelMPrehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark., Lauge Mørk Vammen, Lars W Andersen, and Asger Granfeldt.
• Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
• Crit. Care Med. 2024 Feb 1; 52 (2): e67e78e67-e78.

ObjectivesCurrent international guidelines recommend administrating calcium chloride and sodium bicarbonate to patients with hyperkalemia-induced cardiac arrest, despite limited evidence. The aim of this study was to evaluate the efficacy of calcium chloride and sodium bicarbonate on return of spontaneous circulation (ROSC) in a pig model of hyperkalemia-induced cardiac arrest.DesignA randomized, blinded, placebo-controlled experimental pig study. Hyperkalemia was induced by continuous infusion of potassium chloride over 45 minutes followed by a bolus. After a no flow period of 7 minutes, pigs first received 2 minutes of basic cardiopulmonary resuscitation and subsequently advanced life support. The first intervention dose was administered after the fifth rhythm analysis, followed by a defibrillation attempt at the sixth rhythm analysis. A second dose of the intervention was administered after the seventh rhythm analysis if ROSC was not achieved. In case of successful resuscitation, pigs received intensive care for 1 hour before termination of the study.SettingUniversity hospital laboratory.SubjectsFifty-four female Landrace/Yorkshire/Duroc pigs (38-42 kg).InterventionsThe study used a 2 × 2 factorial design, with calcium chloride (0.1 mmol/kg) and sodium bicarbonate (1 mmol/kg) as the interventions.Measurements And Main ResultsFifty-two pigs were included in the study. Sodium bicarbonate significantly increased the number of animals achieving ROSC (24/26 [92%] vs. 13/26 [50%]; odds ratio [OR], 12.0; 95% CI, 2.3-61.5; p = 0.003) and reduced time to ROSC (hazard ratio [HR] 3.6; 95% CI, 1.8-7.5; p < 0.001). There was no effect of calcium chloride on the number of animals achieving ROSC (19/26 [73%] vs. 18/26 [69%]; OR, 1.2; 95% CI, 0.4-4.0; p = 0.76) or time to ROSC (HR, 1.5; 95% CI, 0.8-2.9; p = 0.23).ConclusionsAdministration of sodium bicarbonate significantly increased the number of animals achieving ROSC and decreased time to ROSC. There was no effect of calcium chloride on the number of animals achieving ROSC or time to ROSC.Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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