A retrospective study on the therapeutic effects of sodium bicarbonate for adult in-hospital cardiac arrest

Abstract

To investigate whether the effects of sodium bicarbonate (SB) during cardiopulmonary resuscitation (CPR) would be influenced by blood pH and administration timing. Adult patients experiencing in-hospital cardiac arrest (IHCA) from 2006 to 2015 were retrospectively screened. Early intra-arrest blood gas data were obtained within 10 min of CPR. Multivariable logistic regression analysis and generalised additive models were used for effect estimation and data exploration, respectively. A total of 1060 patients were included. Only 59 patients demonstrated favourable neurological status at hospital discharge. Blood pH ≤ 7.18 was inversely associated with favourable neurological outcome (odds ratio [OR], 0.24; 95% confidence interval [CI], 0.11–0.52; p value < 0.001) while SB use was not. In the interaction analysis for favourable neurological outcome, significant interactions were noted between SB use and time to SB (SB use × time to SB ≥ 20 min; OR 6.16; 95% CI 1.42–26.75; p value = 0.02). In the interaction analysis for survival to hospital discharge, significant interactions were noted between SB use and blood pH (Non-SB use × blood pH > 7.18; OR 1.56; 95% CI 1.01–2.41; p value = 0.05). SB should not be empirically administered for patients with IHCA since its effects may be influenced by blood pH and administration timing.

Effect of sodium bicarbonate on functional outcome in patients with out-of-hospital cardiac arrest: a post-hoc analysis of a French and North-American dataset

“…Sodium bicarbonate may be beneficial only in those patients with marked acidosis. A retrospective study of in-hospital cardiac arrest concluded that the effects of sodium bicarbonate may depend on blood pH and time of administration [36]. However, routine blood-gas and pH measurement at the scene would be challenging to implement.…”

“…Blood pH may influence the effects of sodium bicarbonate therapy. We used resuscitation duration as a surrogate of blood pH [36]. We thus performed a subgroup analysis by dividing the population into terciles of resuscitation duration.…”

Adjunctive Therapeutics in the Management of Cardiopulmonary Resuscitation: A Narrative Literature Review

“…Furthermore, greatest survival-to-discharge was seen in those without acidemia and not treated with sodium bicarbonate (OR 1.56; 95% CI [1.01-2.4]; p = 0.05). The authors therefore recommend against empiric administration and favor a case-specific approach (e.g., prolonged arrest) [35].…”