Veterans Affairs Hospital, Memphis, TN, USA.
University of Tennessee Health Sciences Center (UTHSC), Memphis, TN, USA.
Ann Pharmacother. 2022 Apr;56(4):436-440. doi: 10.1177/10600280211038393. Epub 2021 Aug 5.
The efficacy of sodium bicarbonate (SB) administration during in-hospital cardiac arrest (IHCA) for treatment of acidosis is not well described. The available literature has only evaluated out-of-hospital arrest events in patients with suspected acidosis caused by prolonged arrest.
This study evaluated SB and its effects on return of spontaneous circulation (ROSC) in patients experiencing IHCA, based on presence of acidosis at baseline as determined by prearrest bicarbonate levels.
We conducted a retrospective cohort study of patients who all received intravenous SB during IHCA. Patients with prearrest bicarbonate levels >21 mmol/L (nonacidotic group) were compared with those with prearrest bicarbonate levels ≤21 mmol/L (acidotic group) for the primary outcome of ROSC.
A total of 225 patients (102 acidotic, 123 nonacidotic) were evaluated. Asystole (37.3% vs 34.1%; = 0.63) and pulseless electrical activity (30.4% vs 29.3%; = 0.85) were the most common presenting rhythms. There were no differences in ROSC in the overall population (53.9% vs 48.8%; = 0.44) or between those who had early (within 20 minutes) or delayed (after 20 minutes) ROSC. Secondary outcomes, including cardiopulmonary resuscitation duration, epinephrine administration, and total SB, were similar between groups.
In this cohort study, administration of SB for IHCA in patients with prearrest acidosis was not associated with increased incidence of ROSC compared with those without prearrest acidosis. Our data suggest that there may be no benefit to the administration of SB in the setting of IHCA, regardless of prearrest acidotic status. Further investigation into the effect of SB for treatment of acidosis in IHCA is warranted.
碳酸氢钠（SB）在院内心搏骤停（IHCA）期间用于治疗酸中毒的疗效尚未得到很好的描述。现有文献仅评估了因长时间停搏而怀疑酸中毒的患者的院外停搏事件。
本研究根据停搏前碳酸氢盐水平确定的基础酸中毒，评估 SB 及其对 IHCA 患者自主循环恢复（ROSC）的影响。
我们对所有在 IHCA 期间接受静脉 SB 治疗的患者进行了回顾性队列研究。将停搏前碳酸氢盐水平＞21mmol/L（非酸中毒组）的患者与停搏前碳酸氢盐水平≤21mmol/L（酸中毒组）的患者进行比较，以评估 ROSC 这一主要结局。
共评估了 225 例患者（102 例酸中毒，123 例非酸中毒）。心搏骤停（37.3% vs 34.1%； = 0.63）和无脉电活动（30.4% vs 29.3%； = 0.85）是最常见的初始节律。在总体人群中，ROSC 无差异（53.9% vs 48.8%； = 0.44），或早期（20 分钟内）或延迟（20 分钟后）ROSC 之间均无差异。次要结局，包括心肺复苏持续时间、肾上腺素的使用和总 SB，在两组之间相似。
在本队列研究中，与无停搏前酸中毒的患者相比，酸中毒的 IHCA 患者给予 SB 治疗并未增加 ROSC 的发生率。我们的数据表明，无论停搏前是否存在酸中毒，SB 治疗 IHCA 酸中毒可能都没有益处。需要进一步研究 SB 治疗 IHCA 酸中毒的效果。
