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Sodium Bicarbonate In In-Hospital and Out-of-Hospital Cardiac Arrest: A Systematic Literature Review
Pedro Manuel Batarda Sena1,2,3, Joao Rodrigues4, Francisco Das Neves Coelho5,6
1Intensive Care Department, Hospital Central do Funchal, Funchal, PRT.
Cureus
|September 30, 2024
Summary
Sodium bicarbonate (SB) is not recommended for routine use during cardiopulmonary resuscitation (CPR) for cardiac arrest. Evidence suggests SB may lower survival rates, with limited benefit only in specific conditions like overdose or hyperkalemia.
Area of Science:
- Emergency Medicine
- Cardiology
- Critical Care Medicine
Background:
- Cardiac arrest is a leading global cause of mortality.
- Sodium bicarbonate (SB) is frequently administered during cardiopulmonary resuscitation (CPR) to address metabolic acidosis (MA).
- The efficacy of SB in CPR remains a subject of ongoing debate and investigation.
Purpose of the Study:
- To systematically review and synthesize the existing evidence on the effectiveness of SB in patients experiencing in-hospital and out-of-hospital cardiac arrest.
- To evaluate the impact of SB administration on patient outcomes during CPR.
Main Methods:
- A comprehensive systematic literature search was conducted across Medline, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL).
- Studies published from November 1962 to December 2023 investigating SB use in cardiac arrest were included.
- A total of 372 records were screened, with 12 studies ultimately included in the review.
Main Results:
- The overall data indicated that SB administration was associated with decreased rates of return of spontaneous circulation (ROSC) and poorer patient outcomes.
- A small number of studies suggested potential benefits of SB in cases of prolonged CPR.
- Limited evidence supports SB use only in specific circumstances, such as hyperkalemic cardiac arrest, severe cardiotoxicity, or tricyclic antidepressant overdose.
Conclusions:
- Sodium bicarbonate is not recommended for conventional use in patients with cardiac arrest.
- Further research is warranted to ascertain the potential benefits of SB in specific, narrowly defined clinical scenarios.
- Current evidence does not support the routine use of SB during CPR outside of specialized indications.
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