Buffer therapy during out-of-hospital cardiopulmonary resuscitation

Dybvik, T; Strand, Terje; Steen, Petter Andreas

doi:10.1016/0300-9572(95)00850-s

Cited by 138 publications

(47 citation statements)

References 27 publications

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“…However, the majority of studies showed no benefit [307][308][309] or found a relationship with poor outcome. 304,310 -312 There are few data to support therapy with buffers during cardiac arrest.…”

Section: Sodium Bicarbonatementioning

confidence: 99%

Part 8: Adult Advanced Cardiovascular Life Support

Neumar¹,

Otto²,

Link³

et al. 2010

Circulation

1,348

872

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Section: Sodium Bicarbonatementioning

confidence: 99%

Part 8: Adult Advanced Cardiovascular Life Support

Neumar¹,

Otto²,

Link³

et al. 2010

Circulation

1,348

872

View full text Add to dashboard Cite

“…In Dybvik et al's series of 257 patients with out-of-hospital arrests receiving no buffer therapy, the average pH at hospital arrival was 7.23, with a range of 7.20 -7.26. 11 The highest pH in our series was 6.81.…”

Section: Discussionmentioning

confidence: 91%

Metabolic Acidosis in Restraint‐associated Cardiac ArrestA Case Series

Hick

Smith

Lynch

1999

Academic Emergency Medicine

156

130

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Abstract. The mechanism of death in patients struggling against restraints remains a topic of debate. This article presents a series of five patients with restraint-associated cardiac arrest and profound metabolic acidosis. The lowest recorded pH was 6.25; this patient and three others died despite aggressive resuscitation. The survivor's pH was 6.46; this patient subsequently made a good recovery. Struggling against restraints may produce a lactic acidosis. Stimulant drugs such as cocaine may promote further metabolic acidosis and impair normal behavioral regulatory responses. Restrictive positioning of combative patients may impede appropriate respiratory compensation for this acidemia. Public safety personnel and emergency providers must be aware of the life threat to combative patients and be careful with restraint techniques. Further investigation of sedative agents and buffering therapy for this select patient group is suggested. Key words: metabolic acidosis; restraint -physical; heart arrest; cardiac arrest. AC-ADEMIC EMERGENCY MEDICINE 1999; 6:239 -243 M ANAGEMENT of violent and agitated patients is a significant problem for public safety and emergency medical agencies, and death occasionally occurs during restraint of these patients. The cause of death in these circumstances has not been elucidated. Speculation has focused on autonomic reflexes, restraint stress, 1 agitated delirium from stimulant drugs, 1 and positional asphyxia due to use of the hobble (or ''hog-tie'') position as potential contributing factors.2 -4 Acidosis has not been cited as a contributing factor in restraint-associated death. Severe metabolic acidosis has, however, been noted with stimulant drug use (notably cocaine), 5 and when exertion and stimulant drug use are combined.6 -8 Profound metabolic acidosis can have significant negative cardiovascular effects, including promotion of dysrhythmias and autonomic instability, which may contribute to cardiovascular collapse.We present five cases of cardiovascular collapse occurring in ED patients who were struggling despite maximal restraint techniques. They were all profoundly acidotic. Our experience with these cases led to institution of an aggressive proactive CASE 1A 36-year-old man was acting extremely agitated and belligerent on a downtown sidewalk. When approached, he attacked a police officer and ran. He was subsequently subdued by several officers. He was transported to the ED, where he continued to fight vigorously while lying prone with his hands cuffed behind him. Breath analysis was negative for ethanol. Shortly thereafter, the patient had a witnessed respiratory arrest. He was intubated within 4 minutes of his apnea. Shortly after intubation, a 15-second episode of asystole was noted; he recovered a sinus rhythm at a rate of 140 beats/ min after epinephrine, atropine, and hyperventilation. His initial arterial blood gas (ABG) obtained 5 minutes after intubation was pH 6.46, pCO 2 49 mm Hg, pO 2 523 mm Hg, and a bicarbonate (HCO 3 ) of 4 mEq/L. Aggressive fluid resus...

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“…235,236 Both had limitations but showed no improvement in outcome. Two retrospective cohort studies also showed no benefit in the use of buffering agents during CPR (LOE 2).…”

Section: Consensus On Sciencementioning

confidence: 96%