An Alternative Sodium Bicarbonate Regimen During Cardiac Arrest and Cardiopulmonary Resuscitation in a Canine Model

Abstract

We evaluated the effect of frequent, early bolus administration of low-dose sodium bicarbonate (NaHCO3) on blood gas values during ventricular fibrillation and cardiopulmonary resuscitation (CPR) compared with normal saline and standard bolus doses of NaHCO3. This was a randomized laboratory investigation involving 13 mongrel dogs and 18 experiments (5 dogs were used in a crossover manner). Each dog underwent 3 minutes of ventricular fibrillation, followed by 15 minutes of CPR. Animals were randomly assigned to one of three treatments administered early in the resuscitation effort: NaHCO3 0.5 mEq/kg at 5, 10, and 15 minutes of ventricular fibrillation (SB); NaHCO3 1 mEq/kg at 5 minutes and 0.5 mEq/kg at 15 minutes of fibrillation (SB); or 0.9% NaCl 1 ml/kg at 5 minutes and 0.5 ml/kg at 15 minutes of fibrillation (P). A total of 15 experiments were included for analysis. Arterial and venous blood gases were sampled at 4, 8, 13, and 18 minutes of fibrillation. The SB group demonstrated the highest arterial partial pressures of carbon dioxide (pCO2) at each sampling point after NaHCO3, including the 18-minute sample: 42 +/- 12, 29 +/- 11, and 35 +/- 10 torr for SB, P, and B, respectively. In addition, SB produced arterial alkalemia (pH > 7.45) after NaHCO3 administration. The arterial pH at 18 minutes of fibrillation for SB, P, and B was 7.46 +/- 0.14, 7.29 +/- 0.07, and 7.41 +/- 0.1, respectively. Similar trends for pCO2 and pH were observed for venous samples.(ABSTRACT TRUNCATED AT 250 WORDS)

RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 4: Advanced life support

“…In the first study, different dosages and modes of sodium bicarbonate therapy were investigated, and it was confirmed that alkalosis developed in response to bicarbonate therapy . In the second study evaluating an early bolus of low‐dose sodium bicarbonate during VF, the investigators found that it was still associated with the development of an alkalosis . Finally, the efficacy of epinephrine as a vasopressor when used in combination with bicarbonate therapy was evaluated in a VF model in dogs .…”

RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 7: Clinical guidelines

“…Several experimental studies in dogs have documented improved survival with bicarbonate therapy with prolonged (>10 min) duration of CPA . However, other experimental studies in dogs have demonstrated worse outcomes and metabolic derangements with bicarbonate therapy, especially when given early in CPR . Given the evidence available, bicarbonate therapy after prolonged CPA of greater than 10–15 minutes with administration of 1 mEq/kg of sodium bicarbonate may be considered (IIb‐B).…”