Abstract 114: Effect of Sodium Bicarbonate on Advanced Cardiac Life Support
Introduction: Current guidelines do not support routine administration of sodium bicarbonate during cardiopulmonary resuscitation (CPR). Previous studies did not recommend bicarbonate unless there is severe metabolic acidosis or hyperkalemia. We hypothesized that the sodium bicarbonate, regardless of its effect on long-term outcomes, may improve the chance of achieving return-of-spontaneous circulation (ROSC).
Methods: We used out of cardiac arrest registry in our hospital and analyzed retrospectively. The primary endpoint was to assess the association between 1) the timing first administration as well as 2) the total amount of sodium bicarbonate administered until ROSC and the chance of achieving ROSC. The secondary endpoint was to assess whether there is significant decrease in early survival if sodium bicarbonate was administered during CPR. We built multivariable logistic regression model by the use of the amount of sodium bicarbonate, age, initial base deficit, serum potassium level and usual Utstein template factors with their p-value < 0.1 in univariable analysis.
Results: Total 697 patients were enrolled. The amount of sodium bicarbonate administered until ROSC (or CPR termination if there is no ROSC) was significantly associated with the chance of ROSC (Odds ratio [OR], 1.10; 95% confidence interval [CI], 1.01-1.19; p=0.028). The association was still valid after additional adjustment with factors with their p-value < 0.1 in univariable conditional logistic regression analysis. (OR, 1.14; 95% CI, 1.01-1.29; p=0.031) The time to first administration of sodium bicarbonate did not show significant univariable association (OR, 0.99; 95% CI, 0.99-1.00; p=0.193). Kaplan-Meyer survival curves showed significantly increased death rate in patients administered with sodium bicarbonate (log-rank test, p=0.002)
Conclusion: Administration of higher dose of sodium bicarbonate during CPR was associated with increased chance of achieving ROSC. However, such benefit was negated soon after by higher early mortality rate in the group where sodium bicarbonate was administered.
Author Disclosures: J. Lee: None.
- © 2014 by American Heart Association, Inc.