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When extracorporeal cardiopulmonary resuscitation fails – Fatal ionized hypocalcemia during cardiac arrest

Patrick Horn
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Patrick Horn
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Affiliations

  • Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University of Düsseldorf, Germany

Correspondence

  • Corresponding author at: University Düsseldorf, Medical Faculty, Division of Cardiology, Pulmonology, and Vascular Medicine, Moorenstr. 5, D-40225, Düsseldorf. Tel.: +49 211 818800; fax: +49 211 8118812.
, MDcorrespondence
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Patrick Horn
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Affiliations

  • Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University of Düsseldorf, Germany

Correspondence

  • Corresponding author at: University Düsseldorf, Medical Faculty, Division of Cardiology, Pulmonology, and Vascular Medicine, Moorenstr. 5, D-40225, Düsseldorf. Tel.: +49 211 818800; fax: +49 211 8118812.
,
Andreas Pasch
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Andreas Pasch
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Affiliations

  • Department of Clinical Chemistry, University Hospital and University of Bern, Inselspital, Bern, Switzerland
, MD
,
Bujar Maxhera
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Bujar Maxhera
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Affiliations

  • Division of Cardiovascular Surgery, Medical Faculty, University of Düsseldorf, Germany
, MD
,
Malte Kelm
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Malte Kelm
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Affiliations

  • Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University of Düsseldorf, Germany
, MD, PhD
,
Ralf Westenfeld
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Ralf Westenfeld
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Affiliations

  • Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University of Düsseldorf, Germany
, MD
DOI: http://dx.doi.org/10.1016/j.ajem.2016.03.060

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Figures

Figure

Accelerated precipitation of calcium and phosphate in serum with increasing phosphate levels. Pooled serum was spiked with 2–10 mM phosphate and precipitation was monitored by nephelometry according to the protocol of Pasch et al. [9] .

Cardiopulmonary resuscitation with assisted extracorporal life-support (ECLS) can be an option in cardiac arrest as a rescue therapy for those patients in whom initial advanced life support is unsuccessful and time is needed to treat a reversible underlying condition as acute intoxication. We report a failure of ECLS due to refractory ionized hypocalcemia, generalized tetany and vasospasm in a case of severe salicylate intoxication and cardiac arrest. (See Fig..)

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Acknowledgement: One author is a co-founder of Calciscon AG, Bern, Switzerland. The authors have no conflicts of interest to declare.

© 2016 Published by Elsevier Inc.
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