Diagnostic Accuracy and Treatment Efficacy of a Prehospital Hyperkalemia Protocol: a Quality Improvement Project (H-46847)

Background: Hyperkalemia (HK) is a serious electrolyte disorder that can result in life-threatening cardiac arrhythmias and is associated with increased mortality risk. Because of the potential for fatal cardiac dysrhythmia, patients with hyperkalemia are often transported to the ED for management (2). It is estimated that more than 800,000 hyperkalemia-related ED visits occur annually in the U.S.

The emergency medical services (EMS) system is responsible for transporting critically ill patients to the hospital. This cohort includes peri-arrest, active arrest and post-cardiac arrest patients. Since HK is a reversible cause of cardiac arrest, it is important to detect this electrolyte abnormality and treat aggressively. However, studies on this disorder are sparse in the prehospital setting.

EMS providers often empirically treat HK during cardiac arrest, however there are also non-arrest patients with clinical features and ECG findings that warrant HK treatment as well. We have instituted a HK protocol for our EMS system to address the gaps in recognizing and treating this potentially fatal condition in the prehospital setting. Our goal is to analyze our initial set of data for quality improvement.

Purpose: The primary objective of the study is to determine the diagnostic accuracy of hyperkalemia (HK) by prehospital providers. The secondary objective is to assess the effectiveness of hyperkalemia treatment in the prehospital setting.

Endpoints:

1. Proportion of subjects who have been correctly diagnosed with hyperkalemia; HK is defined as K greater than or equal to 5.5 mEq/L
2. Frequency of side effects after treatment with anti-hyperkalemia medications.
3. Proportion of subjects whose cardiac rhythm improved with hyperkalemia treatment.

Project status: Enrolling patients from the Emergency Department

Coordinator Role: screen, consent, enroll and collect data.

Open to students: Yes

PI: Dr. Zubaid Rafique