Physiologic response to sodium bicarbonate administration during pediatric in-hospital cardiac arrest

To explore the physiologic response to sodium bicarbonate (SB) administration during pediatric in-hospital cardiac arrest (p-IHCA) and its association with outcomes.

Retrospective single-center study of patients < 18 years old who experienced IHCA with an arterial line in place and received intra-arrest SB from 2013 to 2023. To evaluate the hemodynamic response to SB in isolation, events in which vasopressors were administered the minute before, during or after the first dose of SB were excluded. The primary outcome was the change in diastolic blood pressure (DBP). Patients were classified as SB responders if DBP increased ≥5 mmHg. To assess for a potential enhancement on vasopressor efficacy, a secondary analysis was performed examining the difference-in-difference between the DBP response to epinephrine before and after SB administration.

Thirteen patients were included in the primary analysis, with a median DBP change of 4 mmHg (95% CI: -3, 11 after SB administration (p = 0.31). Of these, 6 (46%) patients were classified as SB responders. There were no significant differences in outcomes between SB responders and non-responders. Ten patients were included in the secondary analysis. There was no significant change in the difference-in-difference between the DBP response to epinephrine before and after SB administration [-2 mmHg (95% CI: -9, 7); p = 0.56].

In this small cohort study, SB administration during p-IHCA was not associated with a significant change in DBP or an augmented DBP response to epinephrine. SB responder status was not associated with outcomes, though power to detect differences was low due to sample size.