Use of sodium bicarbonate in out-of-hospital cardiac arrest: a systematic review and meta-analysis

Abstract

Background Out-of-hospital cardiac arrest (OHCA) is a common cause of death worldwide (Neumar et al., Circulation 122:S729–S767, 2010), affecting about 300,000 persons in the USA on an annual basis; 92% of them die (Roger et al., Circulation 123:e18–e209, 2011). The existing evidence about the use of sodium bicarbonate (SB) for the treatment of cardiac arrest is controversial. We performed this study to summarize the evidence about the use of SB in patients with out-of-hospital cardiac arrest (OHCA). Methods We searched PubMed, Scopus, EBSCO, Web of Science, and Cochrane Library, until June 2019, for randomized controlled trials (RCTs) and observational studies that used SB in patients with OHCA. Outcomes of interest were the rate of survival to discharge, return of spontaneous circulation (ROSC), sustained ROSC, and good neurological outcomes at discharge. Odds ratio (OR) with their 95% confidence interval (CI) were pooled in a random or fixed meta-analysis model. Results A total of 14 studies (four RCTs and 10 observational studies) enrolling 28,412 patients were included; of them, eight studies were included in the meta-analysis. The overall pooled estimate did not favor SB or control in terms of survival rate at discharge (OR= 0.66, 95% CI [0.18, 2.44], p=0.53) and ROSC rate (OR= 1.54, 95% CI [0.38, 6.27], p=0.54), while the pooled estimate of two studies showed that SB was associated with less sustained ROSC (OR= 0.27, 95% CI [0.07, 0.98], p=0.045) and good neurological outcomes at discharge (OR= 0.12, 95% CI [0.09, 0.15], p<0.01). Conclusion The current evidence demonstrated that SB was not superior to the control group in terms of survival to discharge and return of spontaneous circulation. Further, SB was associated with lower rates of sustained ROSC and good neurological outcomes.

Differential diagnosis and cause-specific treatment during out-of-hospital cardiac arrest: a retrospective descriptive study

“…Thrombolysis, the second most common specific intervention in the current study, is associated with good outcomes when given deliberately during OHCA [ 30 , 31 ]. Administration of sodium bicarbonate (NaHCO 3 ) during CA is not routinely recommended due to lack of evidence of benefits [ 1 , 3 , 32 ]. However, it may be beneficial in patients with hyperkalaemia or in certain poisonings [ 1 ].…”

Effect of end-stage kidney disease on the return of spontaneous circulation in Taiwanese adults with out-of-hospital cardiac arrest

“…Another hypothesis was that alkaline compounds (e.g., sodium bicarbonate, tris-hydroxymethyl aminomethane, and tribunate), which had been traditionally used during HD, acted as treatment regimens for metabolic acidosis 27 . However, sodium bicarbonate administration during CPR remained controversial because of its inconsistent benefits 28 – 30 . It induced intracellular acidosis, thereby potentially caused adverse outcomes.…”

A Narrative Review of Drug Therapy in Adult and Pediatric Cardiac Arrest

“…Recently, Alshahrani et al . [ 141 ] published a meta-analysis investigating the effects of SB in CA, including 14 studies (4 RCT and 10 observational studies) with over 28,000 patients. They showed that SB was associated with poorer rates of ROSC and good neurological outcome at discharge [ 141 ].…”