Controversies in Perfusion – 3 – Should you treat an elevated potassium. Hyperkalemia

Panel discussion about hyperkalemia while coming off bypass. There exists a lot of variability on how elevated potassiums are tolerated by clinicians. Hear experiences from the field on how many different practices view what too high a potassium is and how and when it gets treated prior to weaning from bypass. 

Addressing Hyperkalemia in Cardiac Surgery: A Perfusionist's Perspective

Hyperkalemia, or elevated potassium levels in the blood, remains a topic of significant debate in cardiac surgery. This video dives deep into the controversies and clinical practices surrounding the management of hyperkalemia during and after cardiopulmonary bypass, providing perfusionists and cardiac surgery teams with insights into effectively handling this common but critical issue.

Understanding Hyperkalemia in the Cardiac Surgery Context

The discussion begins by setting the stage on what constitutes normal, mild, moderate, and severe hyperkalemia, with normal potassium levels ranging from 3.5 to 5.0 mEq/L. However, the sensitivity to potassium levels above 5.0 mEq/L has significantly increased over the years, influencing decisions about coming off the cardiopulmonary bypass.

Historical Perspective and Current Practices

Reflecting on past decades, the video explores how the management of potassium during cardiac surgeries has evolved. Historically, high potassium levels in cardioplegia were commonplace, with levels frequently reaching into the 6s without concern. Today, there is a heightened sensitivity to potassium levels as low as 5.0 mEq/L, with rigorous measures taken to reduce these levels before concluding bypass.

The Role of Cardioplegia

The conversation shifts to the types of cardioplegia used and their impact on potassium levels. The traditional high-potassium cardioplegia solutions are contrasted against newer practices that may utilize lower potassium concentrations or different formulations to mitigate the risks associated with hyperkalemia.

Clinical Insights and Perfusion Strategies

Key to the discussion is how perfusionists manage elevated potassium levels. Techniques such as adjusting calcium levels, using bicarbonate, insulin, or glucose, and the implications of these choices on patient outcomes are thoroughly examined. The role of non-pulsatile flow during bypass and its effect on the sodium-potassium pumps at the cellular level is discussed, highlighting how normal body processes adjust potassium levels once pulsatile flow resumes.

Interinstitutional Variations and Team Dynamics

The video underscores the variability in hyperkalemia management across different institutions and the importance of teamwork and clear communication among cardiac surgeons, anesthesiologists, and perfusionists. It points out that the lack of standardization can lead to different practices and outcomes, stressing the need for consensus guidelines in managing hyperkalemia in cardiac surgery.

Practical Guidelines for Perfusionists

Practical advice is offered on the best practices for monitoring and adjusting potassium levels during surgery, including the use of advanced monitoring techniques and the latest research findings on potassium management. This section provides actionable steps and protocols that can be implemented in various surgical settings.

Future Directions and Innovations

Looking forward, the discussion touches on upcoming advancements, such as new potassium-binding agents that could revolutionize how hyperkalemia is treated during surgery. These innovations promise to simplify management strategies and improve safety profiles for patients undergoing cardiac procedures.

Case Studies and Real-World Applications

The video includes several case studies that illustrate different scenarios of hyperkalemia management, detailing the decision-making process and the outcomes of each case. These real-world examples provide valuable lessons and insights for perfusionists and other healthcare professionals.

Conclusion

This comprehensive video serves as a critical resource for perfusionists and cardiac surgery teams, offering detailed insights into the management of hyperkalemia during cardiopulmonary bypass. It encourages viewers to consider both traditional and innovative approaches to managing potassium levels, ensuring patient safety and optimal outcomes in cardiac surgery.