Should Sodium Bicarbonate Be Used In Pediatric Arrest?

September 29, 2022

Written by Meghan Breed

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Administration of sodium bicarbonate during in-hospital pediatric cardiac arrest was associated with lower rates of survival to hospital discharge, return of spontaneous circulation, and survival with favorable neurologic outcomes and functional status.

Why does this matter?
The American Heart Association (AHA) and Pediatric Advanced Life Support (PALS) guidelines have recommended against routine use of sodium bicarbonate administration due to potential harm. However, registry data suggest it is still frequently used.

Anyone know any jokes about sodium bicarb? Na…
The study population was obtained through a prespecified secondary analysis of the ICU-RESUS, which was a multicenter, prospective clinical trial evaluating a CPR quality improvement bundle on survival outcomes – a total of 1,100 patients were enrolled.  Research coordinators collected data about child characteristics, event characteristics, and hemodynamic variables pre-arrest and post-arrest.

Of the patients enrolled, 528 (48%) received sodium bicarbonate.  Survival to hospital discharge occurred in 223 patient (42.2%) who received sodium bicarbonate and 419 patients (73.3%) who did not.  Authors concluded that receiving sodium bicarb was associated with a decreased chance of survival to hospital discharge (AOR 0.7; p= 0.010), return of spontaneous circulation (AOR 0.91; p=0.621), survival to discharge with favorable neurologic outcome (AOR 0.69; p=0.007) and favorable functional status (AOR 0.80; p=0.105).

In this study, children who received bicarbonate had higher PRISM and VIS scores, longer CPR duration, greater likelihood of additional resuscitation medications and post-arrest interventions such as ECMO cannulation.  What this suggests to me is that, despite controlling for confounders, this was a sicker patient population to start and would be expected to have a poorer prognosis.

Source
Sodium Bicarbonate Use During Pediatric Cardiopulmonary Resuscitation: A Secondary Analysis of the ICU-RESUScitation Project Trial. Pediatr Crit Care Med. 2022 Jul 26. doi: 10.1097/PCC.0000000000003045. Online ahead of print.