Bicarbonate in Cardiac Arrest: Any Benefit? - Summary - MDSpire
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Bicarbonate in Cardiac Arrest: Any Benefit?
A first-of-its-kind randomized trial in in-hospital cardiac arrest found no statistically significant increase in sustained return of spontaneous circulation with sodium bicarbonate vs placebo.
To evaluate the effect of sodium bicarbonate on sustained return of spontaneous circulation during in-hospital cardiac arrest.
Approach:
Key Findings:
Sustained return of spontaneous circulation occurred in 39% of the sodium bicarbonate group and 37% of the placebo group.
At 30 days, 12% of the sodium bicarbonate group and 9% of the placebo group were alive.
Survival at 30 days with a favorable neurologic outcome occurred in 8% of the sodium bicarbonate group and 5% of the placebo group.
Survival at 90 days was 11% in the sodium bicarbonate group and 8% in the placebo group.
Survival at 90 days with a favorable neurologic outcome occurred in 9% of the sodium bicarbonate group and 7% of the placebo group.
Sodium bicarbonate produced expected physiologic changes but did not improve clinical outcomes.
Alkalosis and hypernatremia were more common in the sodium bicarbonate group.
Interpretation:
The trial found no statistically significant benefit of sodium bicarbonate on sustained return of spontaneous circulation or long-term outcomes in in-hospital cardiac arrest.
Limitations:
The trial was powered for sustained return of spontaneous circulation rather than longer-term outcomes.
Laboratory values could not be measured during cardiac arrest, leading to a heterogeneous population.
The trial was conducted exclusively in Denmark, limiting generalizability.
Conclusion:
Routine administration of sodium bicarbonate during in-hospital cardiac arrest does not improve outcomes and is not supported by current guidelines.
