The association between arrival potassium and 30-day survival following resuscitation from out-of-hospital cardiac arrest: a retrospective cohort study

Background It is unknown whether there is an association between initial serum potassium level and short-term survival in out-of-hospital cardiac arrest (OHCA) survivors. The aim of this study was to describe potential associations between first recorded potassium level and 30-day survival in patien...

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Published in:Scandinavian journal of trauma, resuscitation and emergency medicine Vol. 33; no. 1; pp. 144 - 10
Main Authors: Byrne, Christina, Krogager, Maria Lukacs, Kragholm, Kristian, Pareek, Manan, Mohr, Grimur Høgnason, Ringgren, Kristian Bundgaard, Wissenberg, Mads, Riddersholm, Signe, Wolder, Martin, Folke, Fredrik, Gislason, Gunnar, Køber, Lars, Hassager, Christian, Kjærgaard, Jesper, Fordyce, Christopher B., Torp-Pedersen, Christian, Lip, Gregory Y. H., Barcella, Carlo A.
Format: Journal Article
Language:English
Published: London BioMed Central 26.08.2025
BioMed Central Ltd
Springer Nature B.V
BMC
Subjects:
Aged
Cardiac arrest
Cardiac resuscitation
Cardiopulmonary resuscitation
Cardiopulmonary Resuscitation - methods
Cardiopulmonary Resuscitation - mortality
Care and treatment
CPR
Denmark - epidemiology
Disease
Drug overdose
Emergency medical care
Emergency Medicine
Female
Health aspects
Hospital care
Hospitals
Humans
Male
Measurement
Medical prognosis
Medicine
Medicine & Public Health
Middle Aged
Missing data
Mortality
Out-of-Hospital Cardiac Arrest - blood
Out-of-Hospital Cardiac Arrest - mortality
Out-of-Hospital Cardiac Arrest - therapy
Out-of-hospital cardiac arrest survivors
Patient outcomes
Patients
Potassium
Potassium - blood
Potassium in the body
Registries
Retrospective Studies
Survival
Survival Rate - trends
Traumatic Surgery
Denmark
Out-of-hospital cardiac arrest survivors
Potassium
Survival
ISSN:1757-7241, 1757-7241
Online Access:Get full text
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Summary:Background It is unknown whether there is an association between initial serum potassium level and short-term survival in out-of-hospital cardiac arrest (OHCA) survivors. The aim of this study was to describe potential associations between first recorded potassium level and 30-day survival in patients surviving OHCA. Methods We identified 4,894 patients who had return of spontaneous circulation (ROSC) at hospital arrival, and a registered post-OHCA serum-potassium value, using Danish nationwide registry data from 2001–2019. Potassium values were divided into seven predefined levels: < 2.5, 2.5–2.9, 3.0–3.4, 3.5–4.6, 4.7–5.5, 5.5–6.0, > 6.0 mmol/L. Thirty-day survival was estimated using a multivariable Cox regression (reference normokalemia 3.5–4.6 mmol/L). The multivariable model included age, sex, Charlson comorbidity index (including chronic kidney disease), witnessed status, performance of bystander cardiopulmonary resuscitation (CPR) and first registered heart rhythm. Results Over the 30-day follow-up period, survival rates in the seven strata were as follows: 25 (51.0%), 119 (53.6%), 512 (65.4%), 1,631 (57.9%), 220 (32.7%), 34 (22.8%), and 46 (22.7%), respectively. Thirty-day survival was significantly lower for all groups with hyperkalemia compared with normokalemia: 4.7–5.5 mmol/L: (average risk ratio (RR): 0.72, 95% confidence interval (95% CI): 0.66–0.78); 5.5–6.0 mmol/L: (average RR: 0.60, 95% CI: 0.47–0.73); > 6.0 mmol/L: (average RR: 0.56, 95% CI: 0.46–0.66). Survival did not differ significantly in patients with hypokalemia compared with normokalemia. Conclusions In OHCA survivors, hyperkalemia was associated with reduced 30-day survival compared with normokalemia, independent of age, sex, comorbidity burden and pre-hospital OHCA-characteristics. Conversely, hypokalemia was not associated with reduced 30-day survival.
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ISSN:1757-7241
1757-7241
DOI:10.1186/s13049-025-01454-8