Sodium bicarbonate use during in-hospital pediatric pulseless cardiac arrest – A report from the American Heart Association Get With The Guidelines®-Resuscitation

Abstract

Background: Despite limited recommendations for using sodium bicarbonate (SB) during cardiopulmonary resuscitation (CPR), we hypothesized that SB continues to be used frequently during pediatric in-hospital cardiac arrest (IHCA) and that its use varies by hospital-specific, patient-specific, and event-specific characteristics. Methods: We analyzed 3719 pediatric (<18 years) index pulseless CPR events from the American Heart Association Get With The Guidelines-Resuscitation database from 1/2000 to 9/2010. Results: SB was used in 2536 (68%) of 3719 CPR events. Incidence of SB use between 2000 and 2005 vs. 2006 and 2010 was 71.1% vs. 66.2% (P = 0.002). The primary outcome was survival to discharge. Secondary outcomes included 24-h survival and neurologic outcome. Multivariable logistic regression analyzed the association between SB use and outcomes. SB had increased use an ICU location, metabolic/electrolyte disturbance, prolonged CPR, pVT/VF, and concurrently with other pharmacologic interventions. Adjusting for confounding factors, SB use was associated with decreased 24-h survival (aOR 0.83, 95% CI: 0.69, 0.99) and decreased survival to discharge (aOR 0.80; 95% CI: 0.65, 0.97). Inclusion of metabolic/electrolyte abnormalities, hyperkalemia, and toxicologic abnormalities only (n = 674), SB use was not associated with worse outcomes or unfavorable neurologic outcome. Conclusions: SB is used frequently during pediatric pulseless IHCA, yet there is a significant trend toward less routine use over the last decade. Because SB is more likely to be used in an ICU, with prolonged CPR, and concurrently with other pharmacologic interventions; its use during CPR may be associated with poor prognosis due to an association with “last ditch” efforts of resuscitation rather than causation.

Hydrocortisone Therapy in Catecholamine-Resistant Pediatric Septic Shock: A Pragmatic Analysis of Clinician Practice and Association With Outcomes*

“…This raises the important question of whether clinicians felt compelled to attempt SDH therapy in critically ill children with greater severity of illness and more vasopressor support as a “last ditch” effort, particularly in those with rSTC level ≥ 18 mcg/dL who may have been at higher risk for worse outcomes. This “epiphenomenon” is similar to the well-described associations of worse outcomes with use of medications such as sodium bicarbonate and calcium during prolonged resuscitative efforts in pediatric cardiac arrest (32,33). …”

Lebensrettende Maßnahmen bei Kindern („paediatric life support“)

“…Es besteht keine klare Evidenz für die routinemäßige Verabreichung von Natriumbikarbonat während des Atem-KreislaufStillstands [287][288][289][290] …”

Use of Sodium Bicarbonate During Pediatric Cardiac Admissions with Cardiac Arrest: Who Gets It and What Does It Do?

“…The limited evidence of benefit and potential for harm have led the American Heart Association (AHA) to discourage sodium bicarbonate use in recent resuscitation guidelines [3]. Both the 2005 American Heart Association's (AHA) Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS) guidelines maintain that routine admiration of sodium bicarbonate has not shown to improve outcome of resuscitation [4]. The 2010 ACLS and PALS guidelines do not recommend use of sodium bicarbonate for cardiac arrest unless the target is hyperkalemia or toxidromes [4].…”

“…Although routine use of sodium bicarbonate in pediatric CPR has not been advocated by PALS guidelines, its use during resuscitation remains common. A national database analysis found 68% of pediatric in-hospital cardiac arrests between 2000-2010 received sodium bicarbonate during CPR [4]. The reasoning for its utilization arises from the belief that acidemia impairs myocardial function and diminishes myocardial response to catecholamines [5].…”