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Sodium bicarbonate administration during in-hospital pediatric cardiac arrest: A systematic review and meta-analysis
Chih-Yao Chang1, Po-Han Wu1, Cheng-Ting Hsiao2
1Department of Emergency Medicine, Chang Gung Memorial Hospital, No. 6, W. Sec., Jiapu Rd., Puzih City, Chiayi County 613, Taiwan.
Insights
Sodium bicarbonate (SB) administration during pediatric cardiac arrest is not recommended by current guidelines but is common practice. This meta-analysis found SB use significantly decreased survival to hospital discharge in pediatric patients, supporting current guidelines.
Area of Science:
- Pediatric Critical Care Medicine
- Emergency Medicine
- Cardiology
Background:
- Current Pediatric Life Support (PLS) guidelines do not recommend routine sodium bicarbonate (SB) use in pediatric cardiac arrest.
- Despite guidelines, SB administration remains common in clinical practice for pediatric resuscitation.
- This study aimed to evaluate SB's impact on mortality and neurological outcomes in pediatric in-hospital cardiac arrest (IHCA).
Purpose of the Study:
- To assess the impact of sodium bicarbonate (SB) on survival and neurological outcomes in pediatric patients experiencing in-hospital cardiac arrest (IHCA).
- To provide evidence-based insights into the efficacy of SB during pediatric resuscitation efforts.
Main Methods:
- A systematic literature search was conducted across PubMed, Embase, and Cochrane Central Register of Controlled Trials up to January 2021.
- Included were 7 observational studies involving 4877 pediatric IHCA patients, comparing SB treatment versus no SB treatment.
- Risk of bias and certainty of evidence were assessed using the Newcastle-Ottawa Scale and GRADE system, respectively.
Main Results:
- Meta-analysis of 7 observational studies (4877 patients) revealed that SB administration during pediatric cardiac arrest was associated with significantly decreased survival to hospital discharge (OR, 0.40; 95% CI, 0.25-0.63).
- Subgroup analyses confirmed decreased survival rates regardless of whether the studies were conducted before or after 2010.
- The certainty of evidence for these findings ranged from very low to low, with insufficient data for 24-h survival and neurological outcomes.
Conclusions:
- The findings support current Pediatric Life Support (PLS) guidelines advising against routine sodium bicarbonate administration in pediatric cardiac arrest.
- SB should only be considered in specific, exceptional resuscitation scenarios.
- Further research with higher certainty of evidence is needed to fully elucidate SB's role.
Background:
Current American Heart Association Pediatric Life Support (PLS) guidelines do not recommend the routine use of sodium bicarbonate (SB) during cardiac arrest in pediatric patients. However, SB administration during pediatric resuscitation is still common in clinical practice. The objective of this study was to assess the impact of SB on mortality and neurological outcomes in pediatric patients with in-hospital cardiac arrest.
Methods:
We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials from inception to January 2021. We included studies of pediatric patients that had two treatment arms (treated with SB or not treated with SB) during in-hospital cardiac arrest (IHCA). Risk of bias was assessed using the Newcastle-Ottawa Scale and the certainty of evidence was assessed using GRADE system.
Results:
We included 7 observational studies with a total of 4877 pediatric in-hospital cardiac arrest patients. Meta-analysis showed that SB administration during pediatric cardiac resuscitation was associated with a significantly decreased rate of survival to hospital discharge (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.25-0.63, p value = 0.0003). There were insufficient studies for 24-h survival and neurologic outcomes analysis. The subgroup analysis showed a significantly decreased rate of survival to hospital discharge in both the "before 2010" subgroup (OR 0.47; 95% CI 0.30-0.73; p value = 0.006) and the "after 2010" subgroup (OR 0.46; 95% CI 0.25-0.87; p value = 0.02). The certainty of evidence ranged from very low to low.
Conclusions:
This meta-analysis of non-randomized studies supported current PLS guideline that routine administration of SB is not recommended in pediatric cardiac arrest except in special resuscitation situations.
Trial Registration:
The protocol was registered with PROSPERO on 8 August 2020 (registration number: CRD42020197837).
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