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Related Concept Videos

Cardiopulmonary Resuscitation IV: Pharmacological Management01:25

Cardiopulmonary Resuscitation IV: Pharmacological Management

Pharmacologic intervention is crucial in treating cardiac arrest patients during ACLS or Advanced Cardiovascular Life Support. The ACLS algorithms guide the administration of specific drugs based on the patient's cardiac arrest rhythm, which includes pulseless ventricular tachycardia (VT), ventricular fibrillation (VF), asystole, and pulseless electrical activity (PEA).EpinephrineIndication: Epinephrine is the first-line drug for all cardiac arrest rhythms.Mechanism of Action: Epinephrine...
Bicarbonate-Carbonic Acid Buffer01:22

Bicarbonate-Carbonic Acid Buffer

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Depolarizing Blockers: Pharmocokinetics01:19

Depolarizing Blockers: Pharmocokinetics

Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
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Diagnosing acid-base imbalances involves systematically analyzing arterial blood samples, focusing on three key measurements: pH, bicarbonate (HCO3−) concentration, and carbon dioxide partial pressure (PCO2). This analysis follows a four-step process that helps identify the imbalance's underlying cause and nature.
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Roles of Electrolytes: Chloride and Bicarbonate01:29

Roles of Electrolytes: Chloride and Bicarbonate

Chloride ions contribute to the osmotic pressure gradient distinguishing the intracellular fluid (ICF) from the extracellular fluid (ECF). They counterbalance positively charged ions in the ECF and ensure its electrochemical stability. The renal system's process of chloride absorption and release generally mirrors that of sodium ions.
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Bronsted-Lowry Acids and Bases

The acid-base reaction class has been studied for quite some time. In 1680, Robert Boyle reported traits of acid solutions that included their ability to dissolve many substances, to change the colors of certain natural dyes, and to lose these traits after coming in contact with alkali (base) solutions. In the eighteenth century, it was recognized that acids have a sour taste, react with limestone to liberate a gaseous substance (now known to be CO2), and interact with alkalis to form neutral...

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Utilizing the Modified T-Maze to Assess Functional Memory Outcomes After Cardiac Arrest
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Sodium Bicarbonate for In-Hospital Cardiac Arrest: A Randomized Clinical Trial.

Asger Granfeldt1,2, Bertram Lahn Kirkegaard1,2,3, Mikael Fink Vallentin1,2,3

  • 1Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.

JAMA
|June 11, 2026
PubMed
Summary

Sodium bicarbonate did not improve return of spontaneous circulation in patients with in-hospital cardiac arrest. This study suggests routine administration of sodium bicarbonate is not recommended for cardiac arrest patients.

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Area of Science:

  • Cardiology
  • Emergency Medicine
  • Clinical Trials

Background:

  • In-hospital cardiac arrest (IHCA) is associated with poor patient outcomes.
  • Sodium bicarbonate is frequently used during IHCA, but its clinical impact remains uncertain.

Purpose of the Study:

  • To evaluate the efficacy of sodium bicarbonate in increasing return of spontaneous circulation (ROSC) during IHCA.
  • To assess the impact of sodium bicarbonate on 30-day survival and neurological outcomes post-IHCA.

Main Methods:

  • A randomized, double-blind, placebo-controlled trial involving 913 adult patients with IHCA across 21 Danish hospitals.
  • Participants received either intravenous sodium bicarbonate (up to 100 mmol) or a placebo after at least one dose of epinephrine.
  • Primary outcome was sustained ROSC; secondary outcomes included 30-day survival and favorable neurological status (modified Rankin Scale 0-3).

Main Results:

  • Sustained ROSC occurred in 39% of the sodium bicarbonate group versus 37% in the placebo group (risk ratio [RR], 1.05; 95% CI, 0.88-1.24).
  • Thirty-day survival was observed in 12% of the sodium bicarbonate group and 9.1% of the placebo group (RR, 1.25; 95% CI, 0.84-1.88).
  • Alkalosis and hypernatremia were more frequent in patients receiving sodium bicarbonate.

Conclusions:

  • Administration of sodium bicarbonate did not significantly improve sustained return of spontaneous circulation in patients experiencing in-hospital cardiac arrest.
  • The findings do not support the routine use of sodium bicarbonate for IHCA management.
  • Further research may be needed to identify specific subgroups that could benefit from sodium bicarbonate therapy.