Buffer Solutions May Compromise Cardiac Resuscitation by Reducing Coronary Perfusion Pressure

Kette, Fulvio; Weil, Max Harry; Gazmuri, Raúl J.

doi:10.1001/jama.1991.03470150093037

Cited by 129 publications

(30 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In fact, the hyperosmolarity and CO 2 -generating properties of sodium bicarbonate may be detrimental to myocardial or cerebral function. [75][76][77] Use of sodium bicarbonate is discouraged during brief CPR. If it is used during prolonged arrests unresponsive to other therapy, it should be given only after establishment of adequate ventilation and circulation.…”

Section: Bicarbonatementioning

confidence: 99%

International Guidelines for Neonatal Resuscitation: An Excerpt From the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science

2000

Pediatrics

415

View full text Add to dashboard Cite

The International Guidelines 2000 Conference on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC) formulated new evidenced-based recommendations for neonatal resuscitation. These guidelines comprehensively update the last recommendations, published in 1992 after the Fifth National Conference on CPR and ECC. As a result of the evidence evaluation process, significant changes occurred in the recommended management routines for: • Meconium-stained amniotic fluid: If the newly born infant has absent or depressed respirations, heart rate <100 beats per minute (bpm), or poor muscle tone, direct tracheal suctioning should be performed to remove meconium from the airway. • Preventing heat loss: Hyperthermia should be avoided. • Oxygenation and ventilation: 100% oxygen is recommended for assisted ventilation; however, if supplemental oxygen is unavailable, positive-pressure ventilation should be initiated with room air. The laryngeal mask airway may serve as an effective alternative for establishing an airway if bag-mask ventilation is ineffective or attempts at intubation have failed. Exhaled CO2 detection can be useful in the secondary confirmation of endotracheal intubation. • Chest compressions: Compressions should be administered if the heart rate is absent or remains <60 bpm despite adequate assisted ventilation for 30 seconds. The 2-thumb, encircling-hands method of chest compression is preferred, with a depth of compression one third the anterior-posterior diameter of the chest and sufficient to generate a palpable pulse. • Medications, volume expansion, and vascular access: Epinephrine in a dose of 0.01–0.03 mg/kg (0.1–0.3 mL/kg of 1:10,000 solution) should be administered if the heart rate remains <60 bpm after a minimum of 30 seconds of adequate ventilation and chest compressions. Emergency volume expansion may be accomplished with an isotonic crystalloid solution or O-negative red blood cells; albumin-containing solutions are no longer the fluid of choice for initial volume expansion. Intraosseous access can serve as an alternative route for medications/volume expansion if umbilical or other direct venous access is not readily available. • Noninitiation and discontinuation of resuscitation: There are circumstances (relating to gestational age, birth weight, known underlying condition, lack of response to interventions) in which noninitiation or discontinuation of resuscitation in the delivery room may be appropriate.

show abstract

Section: Bicarbonatementioning

confidence: 99%

International Guidelines for Neonatal Resuscitation: An Excerpt From the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science

2000

Pediatrics

415

View full text Add to dashboard Cite

show abstract

“…48 Also, in absence of vasopressor agents, administration of hypertonic solutions, specially buffer solutions may adversely affect cardiac resuscitation efforts by reducing coronary perfusion pressure below critical thresold. 49 Mintzer shows that sodium bicarbonate infusion decreased base deficits and increased pH though produced no desirable effects or benefits on cardiopulmonary parameters including regional oxygen saturation and fractional tissue oxygen extraction in extremely premature neonates during the first week. 50 A recent study was conducted in resuscitation of hypoxic newborn piglets with severe acidosis, the administration of sodium bicarbonate improved the recovery of pH and HCO 3 -faster than those of hypoxia-reoxygenation controls, particularly during the first hour of regeneration.…”

Section: Mechanism Of Metabolic Acidosis In Neonatementioning

confidence: 99%

Role of Sodium Bicarbonate to Treat Neonatal Metabolic Acidosis: Beneficial or Not

Afrin¹

2017

J. Bangladesh Coll. Phys.

View full text Add to dashboard Cite

Despite the lack of evidence for effectiveness of sodium bicarbonate in treatment of metabolic acidosis in critically ill patients who are admitted in neonatal and pediatric intensive care unit, bicarbonate administration is a common practice and has a long history of widespread use. The justification for persistent use of this controversial therapy comes from a variety of sources, many of them based in philosophy than in science. Clinicians must consider the intervention which will meet the therapeutic objective & existence of strong scientific evidence. To the contrary, there is increasing evidence of this REVIEW ARTICLE detrimental therapy and adverse effects include diminished oxygen delivery to tissues, worsening intracellular acidosis, aggravated myocardial injury, fluctuations in cerebral blood flow, intracranial hemorrhage and reduces the likelihood success of resuscitation. This review summarizes the evidence and examines the controversy over the use of bicarbonate to treat metabolic acidosis in neonate.

show abstract

“…A solução de bicarbonato de sódio não diluída contém 2.000 mOsm/l, que é extremamente hipertônica e associada de maneira independente à maior mortalidade, mesmo após uma reanimação bem sucedida. A hiperosmolaridade pode provocar diminuição da pressão diastólica aórtica, aumento da pressão atrial direita e diminuição da perfusão pulmonar 69 . Além disso, a abrupta elevação da pressão arterial de CO 2 agiria nas arteríolas cerebrais com aumento de perfusão cerebral e conseqüente hemorragia.…”

Section: Bicarbonato De Sódiounclassified

Controversies about the resuscitation of extremely preterm infants in the delivery room

Almeida¹,

Guinsburg²

2005

J Pediatr (Rio J)

View full text Add to dashboard Cite

show abstract

Buffer Solutions May Compromise Cardiac Resuscitation by Reducing Coronary Perfusion Pressure

Abstract: --Hypertonic solutions and specifically buffer solutions administered in the absence of vasopressor agents may adversely affect cardiac resuscitation efforts by reducing CPP below critical thresholds.

Cited by 129 publications

References 16 publications

International Guidelines for Neonatal Resuscitation: An Excerpt From the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science

International Guidelines for Neonatal Resuscitation: An Excerpt From the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science

Role of Sodium Bicarbonate to Treat Neonatal Metabolic Acidosis: Beneficial or Not

Controversies about the resuscitation of extremely preterm infants in the delivery room

Contact Info

Product

Resources

About