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Updated: May 11, 2025
07:52
Expired CO2 Measurement in Intubated or Spontaneously Breathing Patients from the Emergency Department
Published on: January 29, 2011
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Early Sodium Bicarbonate Use in Pediatric In-Hospital Cardiac Arrest: A Single-Center, Retrospective Cohort Study,
Nicole A Duster1, Anne V Grossestreuer2, Jill L Sorcher3
1Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA.
Summary
Early use of sodium bicarbonate (SB) during pediatric in-hospital cardiac arrest (p-IHCA) was not associated with improved survival or return of spontaneous circulation (ROSC). These findings suggest a need to re-evaluate current guidelines for SB administration in p-IHCA.
Area of Science:
- Pediatric Critical Care Medicine
- Emergency Medicine
- Cardiology
Background:
- Sodium bicarbonate (SB) is sometimes used during pediatric in-hospital cardiac arrest (p-IHCA).
- The optimal timing for SB administration in p-IHCA remains unclear.
- Previous studies have not definitively established the impact of early SB on patient outcomes.
Purpose of the Study:
- To investigate the association between the timing of SB administration and outcomes in pediatric patients experiencing in-hospital cardiac arrest (p-IHCA).
- To determine if administering SB within the first 5 minutes of p-IHCA improves the likelihood of hospital survival and return of spontaneous circulation (ROSC).
Main Methods:
- A retrospective cohort study was conducted at a quaternary care academic children's hospital.
- Included were pediatric patients (≤18 years) with pulseless IHCA lasting at least 5 minutes between January 2013 and January 2023.
- Logistic treatment-effects estimation with inverse-probability weighting was used to compare outcomes between early SB (<5 minutes) and no early SB groups.
Main Results:
- Of 243 p-IHCA events, 41% received SB within the first 5 minutes of cardiopulmonary resuscitation (CPR).
- Overall survival to discharge was 44%, and ROSC was achieved in 37% of patients.
- Early SB administration was not significantly associated with improved adjusted odds of survival to discharge (aOR, 0.87) or ROSC (aOR, 0.82).
Conclusions:
- This study found no association between the timing of SB administration and survival or ROSC in pediatric patients with IHCA.
- The findings suggest that current U.S. national guidelines for SB use during p-IHCA may need reevaluation.
- Further research is warranted to clarify the role and optimal use of SB in pediatric resuscitation.
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