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Related Experiment Videos

Pathophysiologic and therapeutic implications of acid-base changes during CPR

M von Planta1, G Bar-Joseph, L Wiklund

  • 1IRRC, University of Pittsburgh, Pennsylvania 15260.

Annals of Emergency Medicine
|February 1, 1993
PubMed
Summary

Acid-base changes during cardiac arrest and CPR are complex. Current evidence does not conclusively prove buffer agents like sodium bicarbonate improve survival, emphasizing airway, breathing, and chest compressions instead.

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Area of Science:

  • Cardiology
  • Emergency Medicine
  • Physiology

Background:

  • Cardiac arrest (CA) and cardiopulmonary resuscitation (CPR) induce complex acid-base disturbances.
  • These changes are linked to a low-perfusion state with hypercarbic and lactic acidosis.
  • The dynamic nature of this state depends on arrest-to-CPR and CPR-to-circulation restoration intervals.

Purpose of the Study:

  • To review experimental data on the role of buffer agents in managing acid-base changes during CPR.
  • To evaluate the controversial use of sodium bicarbonate and other buffers in cardiac arrest scenarios.
  • To determine if buffer therapy improves neurologically intact survival post-CPR.

Main Methods:

  • Review of experimental studies on acid-base balance during CA and CPR.

Related Experiment Videos

  • Analysis of data regarding the efficacy of CO2-generating and CO2-consuming buffers.
  • Assessment of the impact of ventilation and chest compressions on acid-base status.

    • Main Results:

    • Experimental data suggest that very low pH may be compatible with neurologically intact survival.
    • No conclusive evidence shows that CO2-generating or CO2-consuming buffers improve long-term neurologically intact survival after CPR.
    • Adequate ventilation and effective chest compressions are crucial for counterbalancing acidemia during CPR.

    Conclusions:

    • The primary treatment for acid-base changes during CPR relies on airway management, adequate ventilation, effective chest compressions, and early defibrillation.
    • Buffer therapy, particularly sodium bicarbonate, remains controversial due to a lack of controlled clinical studies.
    • Buffer therapy may be considered in cases of prolonged cardiac arrest or pre-existing metabolic acidosis.