6.3. Section III: Resuscitation

Guideline 23.1

Hyperkalaemia: Cardiac Arrest – Special Circumstance

We recommend that hyperkalaemia is considered in all patients who have a cardiac arrest, as part of identifying and treating a reversible cause using the 4 Hs and 4 Ts approach. (1A)

Guideline 24.1

Hyperkalaemia: Cardiac Arrest – Resuscitation Strategy in Haemodialysis Patients

We recommend that standard ALS practice in cardiac arrest be applied to patients requiring dialysis. (1A)

Guideline 24.2

Hyperkalaemia: Cardiac Arrest – Defibrillation Practice in Haemodialysis Patients

We recommend disconnection from dialysis equipment prior to defibrillation unless the dialysis machine is defibrillator proof. (1C)

Guideline 25.1

Cardiac Arrest: Treatment – Intravenous Calcium

We suggest that intravenous calcium chloride is administered if hyperkalaemia is known or suspected to be the cause of cardiac arrest. (2C)  

Guideline 25.2.1

Cardiac Arrest: Treatment – Insulin Glucose

We recommend that 10 units soluble insulin and 25g glucose are administered if hyperkalaemia is known or suspected to be the cause of cardiac arrest. (1B)

Guideline 25.2.2

Cardiac Arrest: Treatment – Insulin Glucose

We suggest a 10% glucose infusion be initiated if the blood glucose is < 7.0 mmol/l at the time of cardiac arrest. (2C)

Guideline 25.3

Hyperkalaemia: Cardiac Arrest – Sodium Bicarbonate

We suggest that sodium bicarbonate is administered if hyperkalaemia is known or suspected to be the cause of cardiac arrest. (2C)

Guideline 25.4

Hyperkalaemia: Cardiac Arrest – Initiation of Dialysis During CPR

We suggest that renal replacement therapy with ongoing CPR may be considered for hyperkalaemic cardiac arrest, if hyperkalaemia is resistant to medical therapy and appropriate staff and facilities are available. (2C)

Guideline 26.1

Hyperkalaemia: Prevention of Cardiac Arrest in Hyperkalaemia

We recommend that hyperkalaemia is treated urgently in patients with severe hyperkalaemia (K⁺ ≥ 6.5 mmol/l) and in those with ECG changes suggestive of severe hyperkalaemia. (1C)

Guideline 26.2

Hyperkalaemia: Prevention of Cardiac Arrest in Hyperkalaemia

We recommend continuous cardiac monitoring for patients with severe hyperkalaemia (K⁺ ≥ 6.5 mmol/l) in a setting appropriate for the level of care required. (1C)

Guideline 26.3

Hyperkalaemia: Algorithm in Cardiac Arrest

We recommend that cardiac arrest attributable to hyperkalaemia is managed using the treatment algorithm which provides guidance on the medical therapies and the need for initiation of renal replacement therapy during CPR. (1C)