Use of Sodium Bicarbonate in Cardiac Arrest: Current Guidelines and Literature Review

Velissaris, Dimitrios; Karamouzos, Vasileios; Pierrakos, Charalampos; Koniari, Ioanna; Apostolopoulou, Christina; Καρανικόλας, Μενέλαος

doi:10.14740/jocmr2456w

Cited by 24 publications

(12 citation statements)

References 47 publications

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“…Few studies investigated the effects of SB use during CPR for IHCA 20 . During CPR, point-of-care blood testing may yield important diagnostic information and guide management 21 .…”

Section: Discussionmentioning

confidence: 99%

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

Wang

et al. 2021

Sci Rep

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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.

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“…Few studies investigated the effects of SB use during CPR for IHCA 20 . During CPR, point-of-care blood testing may yield important diagnostic information and guide management 21 .…”

Section: Discussionmentioning

confidence: 99%

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

Wang

et al. 2021

Sci Rep

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“…That review concluded that bicarbonate therapy demonstrated little benefit and might harm the patients. [ 5 ] The latest ACLS guidelines do not recommend the routine administration of bicarbonates. [ 4 ] However, this following guideline still mentions the use of bicarbonates for correcting the metabolic acidosis, which is a reversible cause of CA.…”

Section: Discussionmentioning

confidence: 99%

“…[ 4 ] Bicarbonate therapy for CA has been an issue of debate. [ 5 ] Two studies showed the positive outcomes with the use of bicarbonate. [ 6 7 ] However, the predominant evidences showed no benefit.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of bicarbonate therapy for adults with cardiac arrest

Wongtanasarasin

Srisurapanont

2021

Turkish Journal of Emergency Medicine

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OBJECTIVES: Because the benefits of bicarbonate therapy remain unclear, it is not routinely recommended for the cardiopulmonary resuscitation (CPR) given to individuals with cardiac arrest (CA). This study aims to evaluate the clinical benefits of bicarbonate therapy in adults with CA. METHODS: Without any language restriction, we searched PubMed/MEDLINE, Scopus, Web of Science, and Cochrane CENTRAL from the inception until April 30, 2020. We performed hand-search to identify the relevant trials included in previous meta-analyses. Included studies were randomized controlled trials (RCTs) comparing bicarbonate and placebo treatment in adults with CA. Two authors independently assessed the trial risk of bias. The primary outcome was the survival to hospital admission. The secondary outcomes included the return of spontaneous circulation, the survival to hospital discharge, and the neurological outcome at discharge. We calculated the odds ratios of those outcomes using the Mantel-Haenszel model and assessed the heterogeneity using the I 2 statistic. RESULTS: Our searches found 649 unduplicated studies. Of these, three RCTs involving 1344 patients were included in the meta-analysis. The trial risk of bias ranged between fair and poor, mainly due to no blindness of outcome assessment and the selective reports of outcomes. Bicarbonate therapy showed no significant improvement in the survival to hospital admission (odds ratio [OR] 0.96; 95% confidence interval [CI] 0.73–1.25). Subgroup analysis in those receiving prolonged CPR showed a similar result (OR 0.88; 95% CI 0.10–8.01). No study reported the predefined secondary outcomes. CONCLUSION: For both acute and prolonged CPR, bicarbonate therapy might not show benefit to improve the rate of survival to hospital admission in adults with cardiac arrest.

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“…In theory, buffering extremely deep acidosis could improve response to catecholamines, increase venous return, and re-establish favorable pharmacokinetics for most administered drugs. The debate on whether a buffer solution might be beneficial or harmful in cardiac arrest was ongoing for decades, leading firstly to inclusion of sodium bicarbonate in resuscitation guidelines, and then in discouraging it [ 65 , 66 ]. In contrast to sodium bicarbonate, sodium lactate dissociation does not lead to an increase in blood and tissular CO 2, and thus, does not contribute to worsen intracellular acidosis.…”

Section: Lactate Enriched Solutions Beyond Neuro-energeticsmentioning

confidence: 99%

Brain Protection after Anoxic Brain Injury: Is Lactate Supplementation Helpful?

Annoni

Peluso

Bogossian

et al. 2021

Cells

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While sudden loss of perfusion is responsible for ischemia, failure to supply the required amount of oxygen to the tissues is defined as hypoxia. Among several pathological conditions that can impair brain perfusion and oxygenation, cardiocirculatory arrest is characterized by a complete loss of perfusion to the brain, determining a whole brain ischemic-anoxic injury. Differently from other threatening situations of reduced cerebral perfusion, i.e., caused by increased intracranial pressure or circulatory shock, resuscitated patients after a cardiac arrest experience a sudden restoration of cerebral blood flow and are exposed to a massive reperfusion injury, which could significantly alter cellular metabolism. Current evidence suggests that cell populations in the central nervous system might use alternative metabolic pathways to glucose and that neurons may rely on a lactate-centered metabolism. Indeed, lactate does not require adenosine triphosphate (ATP) to be oxidated and it could therefore serve as an alternative substrate in condition of depleted energy reserves, i.e., reperfusion injury, even in presence of adequate tissue oxygen delivery. Lactate enriched solutions were studied in recent years in healthy subjects, acute heart failure, and severe traumatic brain injured patients, showing possible benefits that extend beyond the role as alternative energetic substrates. In this manuscript, we addressed some key aspects of the cellular metabolic derangements occurring after cerebral ischemia-reperfusion injury and examined the possible rationale for the administration of lactate enriched solutions in resuscitated patients after cardiac arrest.

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Use of Sodium Bicarbonate in Cardiac Arrest: Current Guidelines and Literature Review

Cited by 24 publications

References 47 publications

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

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

Efficacy of bicarbonate therapy for adults with cardiac arrest

Brain Protection after Anoxic Brain Injury: Is Lactate Supplementation Helpful?

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