Novel Methods for Damage Control of Hyperkalemia in Combat Casualties
Abstract
Current techniques for renal replacement therapy (RRT) require specialized equipment, extensively trained personnel, and large logistical footprints. These constraints have limited the Air Forces ability to provide life-saving treatments in forward-deployed locations. Our approach to RRT ensures negligible increases in equipment and logistical footprint. Furthermore, the use of simplified RRT techniques can be accomplished with minimal training for deployed providers. For this program, three techniques for simplified RRT requiring 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 modified 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, we used a potassium binder with peritoneal dialysis fluid and recycled it to remove potassium. Results for Phase 1 serum potassium concentration was significantly lower in the treatment than in the control group over time (P = 0.02). For Phase 2, no difference was found in electrolyte concentrations between the commercial and improvised replacement solutions. In Phase 3, there was no statistically significant difference in serum potassium between groups over time (p = 0.766). In austere settings, a simplified hemoperfusion system can be used to temporize patients with hyperkalemia until evacuation to a facility with traditional RRT is possible. The ImpRRT system achieved similar performance to CRRT and represents a formidable 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 conventional peritoneal dialysis.
Document Details
- Document Type
- Technical Report
- Publication Date
- Jul 05, 2020
- Accession Number
- AD1165086
Entities
People
- Ian J Stewart
Organizations
- David Grant USAF Medical Center