Wongtanasarasin Wachira, Srisurapanont Karan
Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Turk J Emerg Med. 2020 Dec 1;21(1):24-29. doi: 10.4103/2452-2473.301917. eCollection 2021 Jan-Mar.
Because the benefits of bicarbonate therapy remain unclear, it is not routinely recommended for the cardiopulmonary resuscitation (CPR) given to individuals with cardiac arrest (CA). This study aims to evaluate the clinical benefits of bicarbonate therapy in adults with CA.
Without any language restriction, we searched PubMed/MEDLINE, Scopus, Web of Science, and Cochrane CENTRAL from the inception until April 30, 2020. We performed hand-search to identify the relevant trials included in previous meta-analyses. Included studies were randomized controlled trials (RCTs) comparing bicarbonate and placebo treatment in adults with CA. Two authors independently assessed the trial risk of bias. The primary outcome was the survival to hospital admission. The secondary outcomes included the return of spontaneous circulation, the survival to hospital discharge, and the neurological outcome at discharge. We calculated the odds ratios of those outcomes using the Mantel-Haenszel model and assessed the heterogeneity using the Istatistic.
Our searches found 649 unduplicated studies. Of these, three RCTs involving 1344 patients were included in the meta-analysis. The trial risk of bias ranged between fair and poor, mainly due to no blindness of outcome assessment and the selective reports of outcomes. Bicarbonate therapy showed no significant improvement in the survival to hospital admission (odds ratio [OR] 0.96; 95% confidence interval [CI] 0.73-1.25). Subgroup analysis in those receiving prolonged CPR showed a similar result (OR 0.88; 95% CI 0.10-8.01). No study reported the predefined secondary outcomes.
For both acute and prolonged CPR, bicarbonate therapy might not show benefit to improve the rate of survival to hospital admission in adults with cardiac arrest.
由于碳酸氢盐疗法的益处尚不清楚，因此不常规推荐在对心脏骤停（CA）患者进行的心肺复苏（CPR）中使用。本研究旨在评估碳酸氢盐疗法对成年CA患者的临床益处。
不受任何语言限制，我们检索了从创刊至2020年4月30日的PubMed/MEDLINE、Scopus、科学网和Cochrane CENTRAL。我们进行了手工检索以确定先前荟萃分析中纳入的相关试验。纳入的研究为比较成年CA患者碳酸氢盐和安慰剂治疗的随机对照试验（RCT）。两位作者独立评估试验的偏倚风险。主要结局是入院存活。次要结局包括自主循环恢复、出院存活以及出院时的神经学结局。我们使用Mantel-Haenszel模型计算这些结局的比值比，并使用I统计量评估异质性。
我们的检索共找到649项不重复的研究。其中，三项涉及1344例患者的RCT被纳入荟萃分析。试验的偏倚风险在中等至较差之间，主要原因是结局评估未设盲以及结局的选择性报告。碳酸氢盐疗法在入院存活方面未显示出显著改善（比值比[OR]0.96；95%置信区间[CI]0.73-1.25）。对接受长时间CPR的患者进行的亚组分析显示了类似结果（OR 0.88；95%CI 0.10-8.01）。没有研究报告预设的次要结局。
对于急性和长时间CPR，碳酸氢盐疗法可能无法提高成年心脏骤停患者的入院存活率。
