Extracorporeal Filtration of Potassium in a Swine Model of Bilateral Hindlimb Ischemia-Reperfusion Injury With Severe Acute Hyperkalemia.

Autor: Clemens MS; Office of the Chief Scientist, Wilford Hall Ambulatory Surgical Center, 59th Medical Wing, Joint Base San Antonio, 2200 Bergquist Dr, San Antonio, TX.; San Antonio Military Medical Center, Joint Base San Antonio, 3551 Roger Brooke Dr, San Antonio, TX., Stull MC; Office of the Chief Scientist, Wilford Hall Ambulatory Surgical Center, 59th Medical Wing, Joint Base San Antonio, 2200 Bergquist Dr, San Antonio, TX.; San Antonio Military Medical Center, Joint Base San Antonio, 3551 Roger Brooke Dr, San Antonio, TX., Rall JM; San Antonio Military Medical Center, Joint Base San Antonio, 3551 Roger Brooke Dr, San Antonio, TX., Stewart IJ; Clinical Investigation Facility, David Grant Medical Center, Travis Air Force Base, 101 Bodin Cir, Fairfield, CA.; Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD., Sosnov JA; San Antonio Military Medical Center, Joint Base San Antonio, 3551 Roger Brooke Dr, San Antonio, TX.; Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD., Chung KK; Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD.; United States Army Institute for Surgical Research, Joint Base San Antonio, 3698 Chambers Rd, San Antonio, TX., Ross JD; Office of the Chief Scientist, Wilford Hall Ambulatory Surgical Center, 59th Medical Wing, Joint Base San Antonio, 2200 Bergquist Dr, San Antonio, TX.; Division of Trauma, Critical Care & Acute Care Surgery, Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Rd, Portland, OR.
Jazyk: angličtina
Zdroj: Military medicine [Mil Med] 2018 Nov 01; Vol. 183 (11-12), pp. e335-e340.
DOI: 10.1093/milmed/usy189
Abstrakt: Introduction: Options for the treatment of hyperkalemia in the pre-hospital setting are limited, particularly in the context of natural disaster or during combat operations. Contemporary interventions require extensive resources and technical expertise. Here we examined the potential for a simple, field deployable bridge-dialysis as a countermeasure for acute hyperkalemia induced by prolonged ischemia-reperfusion.
Methods: Twenty female swine were randomized into two experimental groups undergoing a 2-hour bilateral hindlimb ischemia-reperfusion injury. Subsequent to injury, hemoperfusion was performed in the presence (Column) and absence (Sham Control) of a high-affinity potassium-binding column (CytoSorbents, Monmouth Junction, NJ, USA). Serial blood gas and chemistries were sampled. Primary endpoint was changed in serum potassium concentrations post-injury and filtration.
Results: Serum potassium was significantly elevated following ischemia-reperfusion injury in both groups (149% (12) and 150% (22), p < 0.05 vs respective baseline values). There were no differences observed between groups in respect to physiologic parameters; mean arterial pressure, heart rate, systemic vascular resistance, cardiac output, or central venous oxygenation. Filtration resulted in a significant relative decrease in potassium compared with controls after the first hour as determined by repeated measures two-way ANOVA (p < 0.0001) which continued through end of the study. Significant thrombocytopenia was observed in animals undergoing filtration with a mean reduction in platelets measured at T = 480 minutes (168 × 103μL, p < 0.0001 vs baseline).
Conclusions: We demonstrate that serum potassium can be filtered via hemoperfusion utilizing a simple extracorporeal potassium-binding platform, though evolution of this technology will be required to achieve meaningful reduction of potassium in clinically significant hyperkalemia after trauma.
Databáze: MEDLINE
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