Novel Methods for Damage Control of Hyperkalemia in Combat Casualties
Abstract
Objective: Current techniques for renal replacement therapy (RRT) require: 1) specialized equipment, 2) extensively trained personnel and 3) large logistical footprints. These constraints limit the Air Forces ability to provide life-saving treatments in forward deployed locations. Our innovations may allow for these treatments with negligible increases in equipment and logistical footprint. Furthermore, these techniques can be accomplished with minimal training for deployed providers. Methods: For this program, three techniques for simplified RRT that require minimal training and supplies were tested. In the first aim (Phase 2), Field expedient renal replacement therapy, we used a Belmont rapid infuser and improvised fluids to develop an improvised method for renal replacement therapy. In the second aim (Phase 1), Potassium binding hemoperfusion, we developed a novel hemoperfusion filter to remove potassium, leveraging the Belmont as a blood pump. Lastly, in our third aim (Phase 3), Novel peritoneal techniques, using a potassium binder with peritoneal dialysis fluid, the fluid can be recycled to remove potassium Results: Phase 1: Serum potassium concentration was significantly lower in the treatment than in the control group over time (P = 0.02). Phase 2: No difference was found in electrolyte concentrations between the commercial and improvised replacement solutions. Phase 3: There was no statistically significant difference in serum potassium between groups over time (p = 0.766). Conclusions: In austere settings, a simplified hemoperfusion system could be used to temporize patients with hyperkalemia until evacuation to a facility with traditional RRT. The ImpRRT system achieved similar performance to CRRT and may represent a potential option for temporary RRT following disasters. Lastly, the experimental device in Phase 3 used significantly less fluid and was able to control serum potassium levels with similar efficacy to that of peritoneal dialysis.
Document Details
- Document Type
- Technical Report
- Publication Date
- Jul 01, 2020
- Accession Number
- AD1105207
Entities
People
- Ian J Stewart
Organizations
- David Grant USAF Medical Center