Ross Catherine E, Sorcher Jill L, Gardner Ryan, Pannu Ameeka, Kleinman Monica E, Donnino Michael W, Sullivan Amy M, Hayes Margaret M
Division of Medical Critical Care, Department of Pediatrics Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 359 Brookline Avenue, Boston, MA 02115, USA.
Resusc Plus. 2024 Nov 22;20:100830. doi: 10.1016/j.resplu.2024.100830. eCollection 2024 Dec.
Despite recommendations against routine use, sodium bicarbonate (SB) is administered in approximately 50% of adult and pediatric in-hospital cardiac arrest (IHCA).
Cross-sectional electronic survey of adult and pediatric attending physicians at two academic hospitals in Boston, Massachusetts. The survey included two IHCA vignettes. Additional open- and closed-ended items explored clinician beliefs surrounding intra-arrest SB and perspectives on a hypothetical clinical trial comparing SB with placebo.
Of the 356 physicians invited, 224 (63 %) responded. Of these, 54 (24 %) said they would "probably" or "definitely give" SB in Scenario 1 (10-minute asystolic arrest) compared to 110 (49 %) for Scenario 2 (20-minute asystolic arrest; p < 0.001). The most frequently reported indications for SB were: hyperkalemia (78 %); metabolic acidosis (76 %); tricyclic anti-depressant overdose (71 %); and prolonged arrest duration (64 %). Of the 207 (92 %) respondents who reported using intra-arrest SB in at least some circumstances, the most common reasons for use were: "last ditch effort" in a prolonged arrest (75 %) and belief that there were physiologic benefits (63 %). When asked of the importance of a clinical trial to guide intra-arrest SB use, 188 (84 %) respondents felt it was at least of average importance, and 140 (63 %) said they would be "somewhat" or "very comfortable" enrolling patients in a trial comparing SB and placebo in IHCA.
Physicians reported practice variations surrounding cardiac arrest management with SB. Respondents commonly cited metabolic acidosis and prolonged arrest duration as indications for intra-arrest SB, despite not being supported by the American Heart Association's advanced life support guidelines.
尽管有不建议常规使用的建议，但在大约50%的成人和儿童院内心脏骤停（IHCA）中仍使用碳酸氢钠（SB）。
对马萨诸塞州波士顿两家学术医院的成人和儿童主治医生进行横断面电子调查。该调查包括两个IHCA病例。其他开放式和封闭式问题探讨了临床医生对心脏骤停期间使用SB的看法以及对比较SB与安慰剂的假设性临床试验的观点。
在邀请的356名医生中，224名（63%）做出了回应。其中，54名（24%）表示在情景1（10分钟心脏停搏）中“可能”或“肯定会给予”SB，而情景2（20分钟心脏停搏）中为110名（49%）（p<0.001）。最常报告的使用SB的指征为：高钾血症（78%）；代谢性酸中毒（76%）；三环类抗抑郁药过量（71%）；以及心脏骤停持续时间延长（64%）。在至少某些情况下报告在心脏骤停期间使用SB的207名（92%）受访者中，最常见的使用原因是：在长时间心脏骤停中“孤注一掷”（75%）以及认为有生理益处（63%）。当被问及临床试验对指导心脏骤停期间使用SB的重要性时，188名（84%）受访者认为其至少具有中等重要性，140名（63%）表示他们会“有点”或“非常愿意”让患者参加比较SB与安慰剂在IHCA中的试验。
医生报告了在心脏骤停管理中使用SB的实践差异。受访者通常将代谢性酸中毒和心脏骤停持续时间延长作为心脏骤停期间使用SB的指征，尽管美国心脏协会的高级生命支持指南并未支持这一点。
