Using Sodium Bicarbonate During Prolonged Cardiopulmonary Resuscitation in Prehospital Setting; a Retrospective Cross-sectional Study
Archives of Academic Emergency Medicine,
Vol. 11 No. 1 (2023),
15 November 2022
,
Page e41
https://doi.org/10.22037/aaem.v11i1.2002
Abstract
Introduction: Although the 2020 American Heart Association (AHA) guidelines recommend that sodium bicarbonate (SB) be avoided during routine cardiopulmonary resuscitation (CPR) a limited number of studies have examined the effects of SB injection during prolonged CPR (>15 min) in prehospital setting. The present study aimed to examine the effects of prehospital SB use during prolonged CPR on patients’ outcome.
Methods: In this retrospective cross-sectional study adult patients aged >18 years who experienced a non-traumatic, out-of-hospital cardiac arrest (OHCA) were compared regarding three outcomes, namely return of spontaneous circulation (ROSC), ROSC > 20 minute, and survival to discharge, based on receiving or not-receiving SB during CPR.
Results: 330 patients were divided into two equal groups of 165. The two groups had similar conditions regarding gender distribution (p = 0.729); mean age (p = 0.741); underlying diseases (p = 0.027); etiology of arrest (p = 0.135); the initial rhythm (p = 0.324); receiving normal saline solution (p = 1.000), epinephrine (p = 0.848), and atropine during CPR (p = 0.054); and using defibrillation (p = 0.324). Those who received SB had 0.80 times greater likelihood for sustained ROSC (adjusted odds ratio (OR) = 0.80, 95% CI: 0.47–1.37, p = 0.415), 0.93 times greater likelihood for ROSC at the scene (adjusted OR = 0.93, 95% CI: 0.55–1.59, p = 0.798), and 0.34 times greater likelihood for survival to discharge (adjusted OR = 0.34, 95% CI: 0.10–1.17, p = 0.087).
Conclusions: The present study demonstrated that prehospital SB use by EMS during prolonged CPR did not improve ROSC rate at the scene, sustained ROSC, and survival to discharge.
- cardiopulmonary resuscitation
- emergency medical services
- prehospital
- sodium bicarbonate
- treatment outcome
- out-of-hospital cardiac arrest
How to Cite
References
Weng Y-M, Wu S-H, Li W-C, Kuo C-W, Chen S-Y, Chen J-C. The effects of sodium bicarbonate during prolonged cardiopulmonary resuscitation. Am J Emerg Med. 2013;31(3):562-5.
Spencer C, Butler J. Survival after cardiac arrest and severe lactic acidosis (pH 6.61) due to haemorrhage. Emerg Med J. 2010;27(10):800-1.
Jamme M, Ben Hadj Salem O, Guillemet L, Dupland P, Bougouin W, Charpentier J, et al. Severe metabolic acidosis after out-of-hospital cardiac arrest: risk factors and association with outcome. Ann Intensive Care. 2018;8(1):62.
Carr C, Carson KA, Millin MG. Acidemia detected on venous blood gas after out-of-hospital cardiac arrest predicts likelihood to survive to hospital discharge. J Emerg Med. 2020;59(4):e105-e11.
Bar‐Joseph G, Abramson N, Kelsey S, Mashiach T, Craig M, Safar P, et al. Improved resuscitation outcome in emergency medical systems with increased usage of sodium bicarbonate during cardiopulmonary resuscitation. Acta Anaesthesiol Scand. 2005;49(1):6-15.
Wu K-H, Chang C-Y, Chen Y-C, Chang C-P, Hsiao C-T, Weng H-H. Effectiveness of sodium bicarbonate administration on mortality in cardiac arrest patients: a systematic review and meta-analysis. J Emerg Med. 2020;59(6):856-64.
Touron M, Javaudin F, Lebastard Q, Baert V, Heidet M, Hubert H, et al. Effect of sodium bicarbonate on functional outcome in patients with out-of-hospital cardiac arrest: a post-hoc analysis of a French and North-American dataset. Eur J Emerg Med. 2022;29(3):210-20.
Neumar RW, Otto CW, Link MS, Kronick SL, Shuster M, Callaway CW, et al. Part 8: adult advanced cardiovascular life support: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010;122(18_suppl_3):S729-S67.
Neumar RW, Shuster M, Callaway CW, Gent LM, Atkins DL, Bhanji F, et al. Part 1: executive summary: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(18_suppl_2):S315-S67.
Merchant RM, Topjian AA, Panchal AR, Cheng A, Aziz K, Berg KM, et al. Part 1: executive summary: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020;142(16_Suppl_2):S337-S57.
Vukmir RB, Katz L, Group SBS. Sodium bicarbonate improves outcome in prolonged prehospital cardiac arrest. Am J Emerg Med. 2006;24(2):156-61.
Goto Y, Funada A, Goto Y. Duration of prehospital cardiopulmonary resuscitation and favorable neurological outcomes for pediatric out-of-hospital cardiac arrests: a nationwide, population-based cohort study. Circulation. 2016;134(25):2046-59.
Rajan S, Folke F, Kragholm K, Hansen CM, Granger CB, Hansen SM, et al. Prolonged cardiopulmonary resuscitation and outcomes after out-of-hospital cardiac arrest. Resuscitation. 2016;105:45-51.
Huabbangyang T, Klaiangthong R, Prasittichok K, Koikhunthod S, Wanna J, Sudajun N, et al. Comparing Emergency Medical Services Processing Times for Stroke Patients Before and During COVID-19 Pandemic; A Cross-sectional Study. Arch Acad Emerg Med. 2022;10(1):e65.
Thongpitak Huabbangyang P, Tavachai Soion R, Acharee Promdee R, Kasemchai Nguanjinda R, Assanai Chamchan R, Ratree Chaisorn P, et al. Factors associated with successful resuscitation during out-of-hospital cardiac arrest performed by Surgico Medical Ambulance and Rescue Team (SMART), Division of Emergency Medical Service and Disaster, Faculty of Medicine Vajira Hospital, Navamindradhiraj University. J Med Assoc Thai. 2021;104:1-9.
Rosner B. Fundamentals of biostatistics. 5th ed. Duxbury: Thomson learning; 2000.
Ahn S, Kim Y-J, Sohn CH, Seo DW, Lim KS, Donnino MW, et al. Sodium bicarbonate on severe metabolic acidosis during prolonged cardiopulmonary resuscitation: a double-blind, randomized, placebo-controlled pilot study. J Thorac Dis. 2018;10(4):2295-302.
Alshahrani MS, Aldandan HW. Use of sodium bicarbonate in out-of-hospital cardiac arrest: a systematic review and meta-analysis. Int J Emerg Med. 2021;14(1):21.
Chen Y-C, Hung M-S, Liu C-Y, Hsiao C-T, Yang Y-H. The association of emergency department administration of sodium bicarbonate after out of hospital cardiac arrest with outcomes. Am J Emerg Med. 2018;36(11):1998-2004.
Neth MR, Daya MR. Sodium bicarbonate therapy during out-of-hospital cardiac arrest: Is presenting rhythm the key to benefit? Resuscitation. 2023;182:109674.
Kim J, Kim K, Park J, Jo YH, Lee JH, Hwang JE, et al. Sodium bicarbonate administration during ongoing resuscitation is associated with increased return of spontaneous circulation. Am J Emerg Med. 2016;34(2):225-9.
Perkins GD, Graesner J-T, Semeraro F, Olasveengen T, Soar J, Lott C, et al. European resuscitation council guidelines 2021: executive summary. Resuscitation. 2021;161:1-60.
Aufderheide TP, Martin DR, Olson DW, Aprahamian C, Woo JW, Hendley GE, et al. Prehospital bicarbonate use in cardiac arrest: a 3-year experience. Am J Emerg Med. 1992;10(1):4-7.
- Abstract Viewed: 715 times
- pdf Downloaded: 726 times
