ED bicarbonate for out-of-hospital cardiac arrest

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Takeaway

  • Despite adjustment for potential confounders, sodium bicarbonate is linked to markedly improved survival odds for out-of-hospital cardiac arrest (OHCA) patients undergoing emergency department (ED) resuscitation.

Why this matters

  • Studies conflict over whether sodium bicarbonate is a useful addition to acute cardiac life support.
  • 2010 American Heart Association guidelines do not recommend use during cardiopulmonary resuscitation except under specific conditions like hyperkalemia; this recommendation was not revisited in 2015 guidelines.

Key results

  • 15.1% (844/5589) survived to hospital admission.
  • Sodium bicarbonate administration during ED resuscitation correlated with higher survival to admission (aOR, 4.47; 95% CI, 3.82-5.22; P<.001).
  • With single-center chart review (n=464), adjusting for prehospital data, arrest etiology, arterial blood pH (OR, 4.06; 95% CI, 2.54-4.68; P<.001).
  • Higher 30-day survival (HR, 0.84; 95% CI, 0.79-0.89; P<.001); this advantage was not apparent in the chart review.

Study design

  • Cohort analysis of population-based database of adults with nontraumatic OHCA (n=5589), 1997-2012.
  • Researchers compared outcomes of patients receiving (n=1885) vs not receiving sodium bicarbonate in ED, per physician discretion.
  • Confounders adjusted for included use of tricyclic antidepressants.
  • Outcome: survival to hospital admission.
  • Funding: Chiayi Chang Gung Memorial Hospital, Taiwan.

Limitations

  • Retrospective, nonrandomized.
  • Prehospital confounders, ED sodium bicarbonate dosage timing not accounted.
  • Neurologic outcomes not assessed.