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Effectiveness of Sodium Bicarbonate Administration in Out-of-Hospital Cardiac Arrests: An Updated Systematic Review
Guilherme P Zaffari1, Lívia N Duarte2, Ivo Queiroz3
1Emergency Medicine Department, Kingston Health Sciences Centre, Kingston, Canada.
Insights
Sodium bicarbonate (SB) did not improve return of spontaneous circulation or survival in out-of-hospital cardiac arrest (OHCA). Routine SB use is not recommended, but specific situations may warrant its administration.
Area of Science:
- Emergency Medicine
- Cardiology
- Pharmacology
Background:
- The efficacy of sodium bicarbonate (SB) in cardiac arrest without a clear cause remains debated.
- Current guidelines from the American Heart Association do not routinely recommend SB for this indication.
Purpose of the Study:
- To systematically review and synthesize current evidence on the use of SB in out-of-hospital cardiac arrest (OHCA).
- To evaluate the impact of SB on return of spontaneous circulation (ROSC) and survival to discharge in OHCA patients.
Main Methods:
- A systematic literature search was conducted across PubMed, Scopus, and Cochrane databases.
- Included studies were randomized controlled trials (RCTs) and observational studies focusing on SB in OHCA.
- Meta-analysis using a random-effects model was performed to pool Odds Ratios (OR) for primary (ROSC) and secondary (survival to discharge) outcomes.
Main Results:
- Eleven studies (2 RCTs, 9 observational) involving 126,013 patients were analyzed.
- No statistically significant difference was found in ROSC (OR 0.85, 95% CI 0.59-1.23) or survival to discharge (OR 0.63, 95% CI 0.17-2.28) with SB administration.
- The observed trends did not reach statistical significance.
Conclusions:
- Sodium bicarbonate administration in OHCA patients is not associated with improved ROSC or survival to discharge.
- Routine use of SB in OHCA is not supported by current evidence.
- Further research is needed to explore potential benefits in specific contexts like hyperkalemia or tricyclic antidepressant overdose, or with early administration.
Objectives:
The use of sodium bicarbonate (SB) in the treatment of cardiac arrest without known etiology is still controversial and is not routinely recommended by the American Heart Association guidelines. This study summarizes current evidence on the use of SB in out-of-hospital cardiac arrest (OHCA).
Methods:
We systematically searched PubMed, Scopus, and Cochrane databases for randomized controlled trials (RCTs) and observational studies evaluating SB in OHCA. Return of spontaneous circulation (ROSC) was the primary outcome, explicitly defined as the return of a palpable pulse and measurable blood pressure; sustained ROSC (≥20 min) was noted separately. Survival to discharge was a secondary outcome. Using a random-effects model, we pooled Odds Ratios (OR) for binary outcomes with 95% confidence intervals (CI).
Results:
Eleven studies (2 RCTs, 9 observational; N = 126,013) were included. No significant differences were observed in ROSC (OR 0.85, 95% CI 0.59-1.23; p = 0.38) or survival to discharge (OR 0.63, 95% CI 0.17-2.28; p = 0.48).
Conclusions:
Administration of sodium bicarbonate in patients with OHCA was not associated with improved ROSC or survival to discharge. Therefore, its routine use cannot be recommended. However, our review does not exclude the possibility of benefit in selected, guideline-specified contexts such as hyperkalemia or tricyclic antidepressant overdose, or when administered early during resuscitation. Further high-quality studies with standardized reporting of etiology, timing, dose, and airway management are needed to clarify these potential indications.
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