Abnormal Calcium Levels During Trauma Resuscitation Are Associated With Increased Mortality, Increased Blood Product Use, and Greater Hospital Resource Consumption
| Autor: | Patrick M. Reilly, Mark J. Seamon, Emily J. MacKay, Brian P. Smith, Michael D. Stubna, Lewis J. Kaplan, Daniel N. Holena, Jeremy W. Cannon |
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| Rok vydání: | 2017 |
| Předmět: |
endocrine system
medicine.medical_specialty Resuscitation Hypercalcaemia Blood transfusion endocrine system diseases medicine.medical_treatment 030204 cardiovascular system & hematology Article law.invention 03 medical and health sciences 0302 clinical medicine law Blood product medicine Hypocalcaemia Calcium metabolism business.industry nutritional and metabolic diseases 030208 emergency & critical care medicine medicine.disease Intensive care unit Surgery Anesthesiology and Pain Medicine Damage control surgery Anesthesia business hormones hormone substitutes and hormone antagonists |
| Zdroj: | Anesthesia & Analgesia. 125:895-901 |
| ISSN: | 0003-2999 |
| Popis: | BACKGROUND Admission hypocalcemia predicts both massive transfusion and mortality in severely injured patients. However, the effect of calcium derangements during resuscitation remains unexplored. We hypothesize that any hypocalcemia or hypercalcemia (either primary or from overcorrection) in the first 24 hours after severe injury is associated with increased mortality. METHODS All patients at our institution with massive transfusion protocol activation from January 2013 through December 2014 were identified. Patients transferred from another hospital, those not transfused, those with no ionized calcium (Ca) measured, and those who expired in the trauma bay were excluded. Hypocalcemia and hypercalcemia were defined as any level outside the normal range of Ca at our institution (1-1.25 mmol/L). Receiver operator curve analysis was also used to further examine significant thresholds for both hypocalcemia and hypercalcemia. Hospital mortality was compared between groups. Secondary outcomes included advanced cardiovascular life support, damage control surgery, ventilator days, and intensive care unit days. RESULTS The massive transfusion protocol was activated for 77 patients of whom 36 were excluded leaving 41 for analysis. Hypocalcemia occurred in 35 (85%) patients and hypercalcemia occurred in 9 (22%). Mortality was no different in hypocalcemia versus no hypocalcemia (29% vs 0%; P = .13) but was greater in hypercalcemia versus no hypercalcemia (78% vs 9%; P < .01). Receiver operator curve analysis identified inflection points in mortality outside a Ca range of 0.84 to 1.30 mmol/L. Using these extreme values, 15 (37%) had hypocalcemia with a 60% mortality (vs 4%; P < .01) and 9 (22%) had hypercalcemia with a 78% mortality (vs 9%; P < .01). Patients with extreme hypocalcemia and hypercalcemia also received more red blood cells, plasma, platelets, and calcium repletion. CONCLUSIONS Hypocalcemia and hypercalcemia occur commonly during the initial resuscitation of severely injured patients. Mild hypocalcemia may be tolerable, but more extreme hypocalcemia and any hypercalcemia should be avoided. Further assessment to define best practice for calcium management during resuscitation is warranted. |
| Databáze: | OpenAIRE |
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