Sodium bicarbonate in cardiac arrest: A reappraisal

The routine use of sodium bicarbonate in patients with cardiac arrest has been discouraged, without the benefit of outcome evaluation. Current recommendations include an elaborate stratification of circumstances in which bicarbonate is to be used. The physiological and clinical aspects of bicarbonat...

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Bibliographic Details
Published in:American Journal of Emergency Medicine 1996-03, Vol.14 (2), p.192-206
Main Authors: Vukmir, Rade B, Bircher, Nicholas, Safar, Peter
Format: Article
Language:English
Subjects:
Acid-Base Equilibrium
acidemia
acidosis
Acidosis - drug therapy
alkalemia
alkalosis
Animals
Biological and medical sciences
cardiac arrest
cardiopulmonary arrest
cardiopulmonary resuscitation
Cardiovascular system
Central Nervous System - drug effects
Disease Models, Animal
Heart - drug effects
Heart Arrest - drug therapy
Heart Arrest - metabolism
Heart Arrest - physiopathology
Hemodynamics - drug effects
Humans
intensive care
Lung - drug effects
Medical sciences
Miscellaneous
Myocardium - metabolism
outcome
Pharmacology. Drug treatments
Resuscitation
sodium bicarbonate
Sodium Bicarbonate - pharmacology
Sodium Bicarbonate - therapeutic use
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Summary:The routine use of sodium bicarbonate in patients with cardiac arrest has been discouraged, without the benefit of outcome evaluation. Current recommendations include an elaborate stratification of circumstances in which bicarbonate is to be used. The physiological and clinical aspects of bicarbonate administration during cardiopulmonary resuscitation in animal and human studies were reviewed. The onset of significant acidemia or alkalemia is associated with adverse system-specific effects. The administration of bicarbonate may mitigate the adverse physiological effects of acidemia, improve response to exogenously administered vasopressor agents, or simply increase venous return due to an osmolar effect, resulting in increased coronary perfusion pressure. Likewise, bicarbonate may have adverse effects in each of these areas. The preponderance of evidence suggests that bicarbonate is not detrimental and may be helpful to outcome from cardiac arrest. An objective reappraisal of the empirical use of bicarbonate or other buffer agents in the appropriate “therapeutic window” for cardiac arrest patients may be warranted.
ISSN:0735-6757
1532-8171
DOI:10.1016/S0735-6757(96)90133-3