Background: Severe hyperkalaemia may be life-threatening, especially in patients with renal failure who are unable to excrete potassium. Various therapies including intravenous sodium bicarbonate, insulin/glucose infusion as well as several beta-2 agonists have been proposed for management of hyperkalaemia. However, if the potassium concentration increases rapidly and the situation becomes critical, haemodialysis may be used. External cardiac compressions can provide adequate blood flow.
Case report: We report a case of a 53-year-old male drunk, multiple trauma patient who was admitted after falling from the tree 40 h earlier. Patients was tetraplegic and anuric. His serum potassium concentration was 8.5 mmol L(-1). Shortly after admittance he arrested and standard CPR was commenced. Because of hyperkalaemia veno-venous haemodialysis was initiated via the internal jugular vein. Blood flow was adequate. After 40 min of resuscitation serum potassium decreased to 5.44 mmol L(-1) and spontaneous sinus rhythm returned. Patient regained consciousness and could move his limbs. After another four dialysis he recovered completely.
Conclusion: Haemodialysis should be considered as a rescue method during hyperkalaemic cardiac arrest if standard CPR and treatment of hyperkalaemia is not effective, even if there is no spontaneous circulation present.