Successful Acute Hemodialysis Performed immediately after Cardiac Arrest due to Uremia

We report a patient with uremia due to polycystic kidneys who developed cardiopulmonary arrest shortly after admission. The initial laboratory data revealed severe acidosis and hyperkalemia caused by terminal uremia. The patient was resuscitated after 20 minutes of cardiac massage with the administration of epinephrine and other inotropic agents. Subsequently, acute hemodialysis was performed even though a stable circulation could not be maintained by the constant infusion of dopamine. It is very important to take immediate steps to correct the severe acidosis and significant derangements of electrolytes which are present in cardiac emergencies due to uremia. Introduction The survival rate after cardiopulmonary arrest has improved greatly since the descripsion of cardiopulmonary resuscitation (CPR) techniques by Kouwenhovenl) in 1960. Cardiac resuscitation in a series of 552 patients at The Royal Victoria Hospital had a survival rate of 21%, but there was only one successful resuscitation among 32 patients with uremia2) . We report a patient with cardiopulmonary arrest due to terminal ueremia who was successfully resuscitated after undergoing acute hemodialysis. Case Report A 35-year-old man was admitted in an unconscious state with marked acetone breath. He suffered a cardiopulmonary arrest shortly after admission. Cardiac massage was commenced and he was intubated. Epinephrine (2mg) was given as an intravenouse bolus and a constant infusion of dopamine (15pg/kg per min) was begun. His pupils were about 6. 5mm in diameter and nonreactive to light. The patient had a history of mild renal dysfunction and hypertension of 10 years duration but he had never taken any medication for these problems. Initial laboratory investigation revealed the following data : pH, 7. 014 ; PaCO2, 8. 7 torr ; and Pa02, 151. 1 torr (on an Fi02 of O. 2, since oxygen was given in the ambulance before arrival). The following initial data were also obtained; sodium, 144mEq/1; potassium, 7. 6mEq/1 ; chloride, 111mEq/1; creatinine, 35. 4mg/d1; BUN, 312mg/dl; glucose, 210mg/di; s-amylase, 1339U/1; Hct, 17. 6%; WBC, 9, 600/mm3; platelets, 11, 700/mm3 ; and CRP 15. 8mg/dt. The data indicated severe renal insufficiency and anemia. He was next given 250s1 of 7% sodium bicarbonate. A chest X-ray showed opacity 1n the left lung field, and blood-streaked of the sputum was observed. Over the same part of the chest, moist rales were heard on auscultation. After 20 minutes of CPR he was resuscitated. Following the insertion of a dual lumen subclavian catheter, acute hemodialysis was performed using a 0. 8m2 membrane surface hemofilter. The flow was set at 70n€/min initially, and a continuous dopamine infusion was given at a rate that changed, depending on the blood pressure. Despite fluctuations in blood pressure, hemodialysis was continued for 3 hours (Fig. 1) . During dialysis, ECG monitoring revealed ventricular premature beats, but these did not become a serious problem. Transfusions of 1, 000s1 of packed red blood cells and 500m1 of fresh frozen plasma