Cardiac Arrest and Sodium Bicarbonate Use

Cardiac Arrest and Sodium Bicarbonate Use

Between January and June of this year, 50 patients received sodium bicarbonate (bicarb) while in cardiac arrest.

There were 23 cases in which the report listed the administration of bicarb under standing orders AND it was not administered to a renal failure patient with calcium.  The other 27 cases either listed the medication as under a physician order or with calcium to a renal patient.

We wanted to remind everyone that sodium bicarbonate is not a medication that should be administered without a physician order in cardiac arrest (unless following the Dialysis-Renal Failure protocol in conjunction with the cardiac arrest protocol).

Per both the 2010 and 2015 ECC Guidelines “Routine administration of sodium bicarbonate is not recommended in cardiac arrest (Class III, LOE B)”.  Aside from special resuscitation situations, bicarb is the exception to the rule and has been shown to have poor outcomes with cardiac arrest patients.

https://eccguidelines.heart.org/index.php/circulation/cpr-ecc-guidelines-2/part-7-adult-advanced-cardiovascular-life-support/   (Part 7, Section 5.7.2)

In addition, bicarb is only mentioned in conjunction with dialysis patients in cardiac arrest, crush syndrome, suspected tricyclic overdose and hyperkalemia in our TEMS protocols.  The medication is not mentioned at all in the most current AHA ACLS Provider Manual.

Our OMD, Dr. Martin, states administration should be rare.  We will continue to monitor usage in the coming months and appreciate your assistance with using it appropriately.  We are also aware that physicians may follow different paths in their treatment but the science is clear at this time that it usually does more harm than good.

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