Abstract 10888: Impact of Sodium Bicarbonate on Survival in Patients With Prolonged Out-of-Hospital Cardiac Arrest; SOS-KANTO study 2002 & 2012
Introduction: The impact of sodium bicarbonate (SB) usage on survival outcomes in patients who have prolonged cardiac arrest (CA) remains unclear. A change in the overall use of SB has occurred over the last decade due to changes in ILCOR recommendations. This natural experiment in the SB use provides an opportunity to explore the association of SB and possible benefits in survival from CA.
Objective: To evaluate the association between SB use and outcomes of CA patients; and to describe temporal patterns of SB use and factors related to SB usage
Methods: In 2002-03 and 2012-13, we identified 9,592 and 16,452 patients, respectively, from two cohorts in Japan. All adult OHCA patients were included. Patients who gained return of spontaneous circulation in pre-hospital settings were excluded as prolonged CA was selected. The primary and secondary outcomes were successful hospital admission and 1 month survival. Factors associated with SB usage were assessed by multivariable logistic regression analysis.
Results: Overall SB usage decreased from 17.3% (n=6,652) in 2002, to 9.7% (n=10,970) in 2012. Patients who received SB had significantly higher rates of admission compared with non-SB patients during both time periods (33.8% vs. 15.4% in 2002, and 39.3% vs. 17.2% in 2012, respectively, p<.001) and significantly higher 1m-survival (4.8% vs. 2.1%, and 4.1% vs. 1.9%, p<.001). Logistic regression demonstrated that SB use was significantly associated with admission (adjusted odds ratio, 2.74 [95%CI 2.29-3.27], p<0.001 in 2002, and 2.68 [2.27-3.18], p<0.001 in 2012) and 1m-survival (2.07 [1.42-3.01], p<0.001, and 1.55 [1.05-2.29], p=0.03) adjusting for possible confounders. Intubation and defibrillation within the ER were most associated with SB usage in both cohorts, while blood pH, potassium levels, and cause of poisoning were not associated with SB use in either cohort.
Conclusions: SB usage was associated with increased survival rates in patients with OHCA transported to the ED in CA. Factors related to current CPR guidelines, that suggest more prolonged ED efforts such as intubation and defibrillation are associated with SB use. Surprisingly blood pH showed no association with SB use. Additional studies on the optimal role for SB during CA seem warranted.
Author Disclosures: K. Shinozaki: Employment; Significant; The Children's Hospital of Philadelphia. T. Ogasawara: None. S. Oda: None. A. Sakurai: None. Y. Tahara: None. N. Yohemoto: None. K. Nagao: None. A. Yaguchi: None. N. Morimura: None.
- © 2015 by American Heart Association, Inc.