J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Review

Volume 8, Number 4, April 2016, pages 277-283

Use of Sodium Bicarbonate in Cardiac Arrest: Current Guidelines and Literature Review

**Table 1.** Clinical Studies Evaluating the Effect of Sodium Bicarbonate in Cardiac Arrest
Author	Origin, year	Study design	Findings
ABG: arterial blood gas; ACLS: advanced cardiac life support; CI: confidence interval; CPR: cardiopulmonary resuscitation; min: minutes; epi: epinephrine; pts: patients; OR: odds ratio; RCT: randomized controlled trial; ROSC: return of spontaneous circulation; SB: sodium bicarbonate.
Aufderheide et al [24]	Wisconsin, USA, 1992	Retrospective chart review, 619 arrest pts, 273 had ROSC	No association between SB and survival
Bar-Joseph et al [15]	Pittsburgh, PA, USA, 2002	Retrospective study, 2,915 pts from brain resuscitation clinical trial III dataset	SB given in 54% of cases, use increased with ACLS duration. SB should probably be given earlier.
Bar-Joseph et al [4]	Pittsburgh, PA, USA, 2005	Retrospective study, 2,122 pts from brain resuscitation clinical trial III dataset with ACLS lasting < 30 min	Earlier and more frequent use of SB associated with higher resuscitation rates and better long-term outcome
Bishop and Weisfeldt [25]	Baltimore, MD, 1976	Experimental data from seven dogs, clinical data from six cardiac arrest pts	SB increases PCO₂, accentuates intracellular acidosis in poorly ventilated pts, may be useful in well-ventilated pts
Delooz and Lewi [25]	Leuven, Belgium, 1989	Retrospective data analysis	SB > 1 mEq/kg associated with poor outcome
Dybvik et al [11]	Oslo, Norway, 1995	RCT, SB (245 pts) vs. 0.9% NS (257 pts)	SB therapy had no effect on outcome
Geraci et al [18]	Jacksonville, FL, USA, 2009	Retrospective chart review, all CPR cases in 2005 - 2006, 88 pts received SB	SB linked with alkalemia in 16% of pts, recommendation for early collection of ABG sample
Mattar et al [22]	Los Angeles, CA, USA, 1974	Case series, 12 pts, SB in cardiac arrest	Plasma osmolality > 400 mOsm/kg, serum Na concentrations > 200 mEq/L
Roberts et al [9]	Winnipeg, Manitoba, Canada, 1990	Retrospective study, 326 pts	Survival 4.2% (10/238) when SB given vs. 27.8% (20/72) when SB not given (P = 0.049) but SB use may reflect presence of severe acidosis
Stiell et al [10]	Ottawa, ON, Canada, 1995	Observational cohort study, 529 pts in 2 years received epi per ACLS guidelines	Logistic regression did not show association between SB and survival
Suljaga-Pechtel et al [27]	New York, NY, USA, 1984	Prospective observational study, 277 arrests in 226 pts	Survival lower in pts who needed SB, likely due to illness severity
van Walraven [12]	Ottawa, ON, Canada, 1998	Prospective cohort study, 773 pts with cardiac arrest, logistic regression for OR and 95% CI	269 of 773 pts survived the first hour. SB use significantly associated with unsuccessful resuscitation
Vukmir and Katz [16]	Pittsburgh, USA, 2006	RCT, 792 patients, SB (420 pts) vs. placebo (372 pts)	Overall survival 13.9% (110/792), no difference between groups. Trend for improved survival with SB in prolonged (> 15 min) arrest
Weaver et al [28]	Seattle, WA, USA, 1990	RCT, lidocaine (n = 106) vs. epi (n = 93); historical controls (n = 132) for SB	Higher survival with SB infusion, which was done before the study started
Weil et al [23]	Chicago, IL, USA, 1985	Cohort study, 105 cardiac arrest pts, all received SB	Survival lower if pH > 7.55 within 10 min of CPR
Weng et al [21]	Taiwan, 2013	Retrospective cohort, 92 pts (30 with vs. 62 without SB)	SB did not improve rate of ROSC in prolonged (> 15 min) cardiac arrest

Table 1. Clinical Studies Evaluating the Effect of Sodium Bicarbonate in Cardiac Arrest

Author

Origin, year

Study design

Findings

ABG: arterial blood gas; ACLS: advanced cardiac life support; CI: confidence interval; CPR: cardiopulmonary resuscitation; min: minutes; epi: epinephrine; pts: patients; OR: odds ratio; RCT: randomized controlled trial; ROSC: return of spontaneous circulation; SB: sodium bicarbonate.

Aufderheide et al [24]

Wisconsin, USA, 1992

Retrospective chart review, 619 arrest pts, 273 had ROSC

No association between SB and survival

Bar-Joseph et al [15]

Pittsburgh, PA, USA, 2002

Retrospective study, 2,915 pts from brain resuscitation clinical trial III dataset

SB given in 54% of cases, use increased with ACLS duration. SB should probably be given earlier.

Bar-Joseph et al [4]

Pittsburgh, PA, USA, 2005

Retrospective study, 2,122 pts from brain resuscitation clinical trial III dataset with ACLS lasting < 30 min

Earlier and more frequent use of SB associated with higher resuscitation rates and better long-term outcome

Bishop and Weisfeldt [25]

Baltimore, MD, 1976

Experimental data from seven dogs, clinical data from six cardiac arrest pts

SB increases PCO₂, accentuates intracellular acidosis in poorly ventilated pts, may be useful in well-ventilated pts

Delooz and Lewi [25]

Leuven, Belgium, 1989

Retrospective data analysis

SB > 1 mEq/kg associated with poor outcome

Dybvik et al [11]

Oslo, Norway, 1995

RCT, SB (245 pts) vs. 0.9% NS (257 pts)

SB therapy had no effect on outcome

Geraci et al [18]

Jacksonville, FL, USA, 2009

Retrospective chart review, all CPR cases in 2005 - 2006, 88 pts received SB

SB linked with alkalemia in 16% of pts, recommendation for early collection of ABG sample

Mattar et al [22]

Los Angeles, CA, USA, 1974

Case series, 12 pts, SB in cardiac arrest

Plasma osmolality > 400 mOsm/kg, serum Na concentrations > 200 mEq/L

Roberts et al [9]

Winnipeg, Manitoba, Canada, 1990

Retrospective study, 326 pts

Survival 4.2% (10/238) when SB given vs. 27.8% (20/72) when SB not given (P = 0.049) but SB use may reflect presence of severe acidosis

Stiell et al [10]

Ottawa, ON, Canada, 1995

Observational cohort study, 529 pts in 2 years received epi per ACLS guidelines

Logistic regression did not show association between SB and survival

Suljaga-Pechtel et al [27]

New York, NY, USA, 1984

Prospective observational study, 277 arrests in 226 pts

Survival lower in pts who needed SB, likely due to illness severity

van Walraven [12]

Ottawa, ON, Canada, 1998

Prospective cohort study, 773 pts with cardiac arrest, logistic regression for OR and 95% CI

269 of 773 pts survived the first hour. SB use significantly associated with unsuccessful resuscitation

Vukmir and Katz [16]

Pittsburgh, USA, 2006

RCT, 792 patients, SB (420 pts) vs. placebo (372 pts)

Overall survival 13.9% (110/792), no difference between groups. Trend for improved survival with SB in prolonged (> 15 min) arrest

Weaver et al [28]

Seattle, WA, USA, 1990

RCT, lidocaine (n = 106) vs. epi (n = 93); historical controls (n = 132) for SB

Higher survival with SB infusion, which was done before the study started

Weil et al [23]

Chicago, IL, USA, 1985

Cohort study, 105 cardiac arrest pts, all received SB

Survival lower if pH > 7.55 within 10 min of CPR

Weng et al [21]

Taiwan, 2013

Retrospective cohort, 92 pts (30 with vs. 62 without SB)

SB did not improve rate of ROSC in prolonged (> 15 min) cardiac arrest