UMEM Educational Pearls

Category: EMS

Title: Acidotic But Not Dead Yet? Sodium Bicarbonate in Cardiac Arrest

Keywords: Cardiac arrest, Sodium Bicarbonate, EMS, Tricyclic Antidepressant (PubMed Search)

Posted: 10/4/2024 by Ben Lawner, MS, DO
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Background:
Despite a lack of reliable evidence, sodium bicarbonate (SB) still appears in various protocols as a potential therapy for patients in cardiac arrest. Local EMS protocols also endorse the use of (SB) in specific scenarios such as: tricyclic overdose and hyperkalemia. EMS systems struggle to articulate best practices with respect to indications for SB administration.

Patients/methods:
Study authors conducted a scoping review of existing literature. The review included in hospital and out of hospital patients with cardiac arrest. Despite multiple studies looking at this question, a total of 12 were included in the final analysis. Criteria for inclusion were as follows: RCT or observational studies looking at patients aged 18 or older who experienced a cardiac arrest. Important outcome metrics incorporated: neurological recovery and survival to discharge.

Results:
The retrospective review failed to demonstrate a reliable association between survival and administration of sodium bicarbonate. Despite significant limitations (different study populations, retrospective designs), there remains insufficient evidence to consider routine administration of bicarb in the setting of cardiac arrest.

Bottom line:
Empiric administration of SB is not linked to a reliable benefit. SB may be considered for specific indications (tricyclic overdose, hyperkalemia) but is unlikely to improve outcomes such as neurologic recovery or hospital discharge. EMS systems should avoid recommending routine SB administration for patients with out of hospital cardiac arrest.

References

Batarda Sena PM, Rodrigues J, Das Neves Coelho F, Soares Nunes B, Fernandes O, Fernandes N, Nóbrega JJ. Sodium Bicarbonate In In-Hospital and Out-of-Hospital Cardiac Arrest: A Systematic Literature Review. Cureus. 2024 Aug 30;16(8):e68192. doi: 10.7759/cureus.68192. PMID: 39347297; PMCID: PMC11439239.