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Analytic Reviews : Acid-Base Abnormalities in Cardiopulmonary Arrest: Varying Patterns in Different Locations Within the Hospital

Department of Medicine, Division of Renal Diseases, Rhode Island Hospital, and the Division of Biological and Medical Sciences, Brown University, Providence, RI

Joseph A. Chazan, MD

Department of Medicine, Division of Renal Diseases, Rhode Island Hospital, and the Division of Biological and Medical Sciences, Brown University, Providence, RI

Arterial blood gas analysis performed in 67 episodes who suffered cardiopulmonary arrest revealed that the degree of acidemia correlated with the location of the patient within the hospital: emergency department (ED), general hospital bed (HB), or intensive care unit (ICU). Acidemia was most severe in patients who pre sented either in the ED (pH = 7.15) or in a HB (pH = 7.10) as a result of combined metabolic (bicarbonate ion [HCO ₃ ^-] = 20 ± 16 and 15 ± 10 mEq/L) and respiratory acidosis (arterial carbon dioxide tension [PaCO₂] = 59 ± 30 and 50 ± 24 mm Hg). In contrast, patients in the ICU had only mild acidemia or even alkalemia (pH = 7.28); respiratory acidosis was un common in this setting (PaCO₂ = 36 ± 18 mm Hg), and patients exhibited a degree of metabolic acidosis ([HCO₃ ^- ] = 18 ± 8 mEq/L) similar to that seen in patients in EDS or HBS. This relative hypocarbia seen in patients in the ICU was attributed to the fact that most (14 of 22, 64% ) were already receiving mechanical ven tilation at the time of the cardiopulmonary arrest. Pa tients who were successfully resuscitated (20, 30% ) did not differ from those in whom resuscitation failed (47, 70% ) in degree of acidemia or location of arrest. Serum potassium levels obtained in 29 patients at the time of arrest revealed that serum potassium levels were greater than 5.2 mEq/L only 8 times; there was only one mea surement greater than 6.0 mEq/L, which did not corre late with the degree of acidemia.

Journal of Intensive Care Medicine, Vol. 4, No. 6, 243-247 (1989)
DOI: 10.1177/088506668900400602


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