Bicarbonate in arrest

The Resus Room

Simon Laing

Science, Emergencymedicine, Medicine, Health & Fitness, Em, Ae

4.8 • 678 Ratings

🗓️ 11 September 2017

⏱️ 17 minutes

🔗️ Recording | iTunes | RSS

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Summary

Bicarbonate use in cardiac arrest.

The topic still provokes debate and multiple publications on the topic still hit the press reels. People talk of the increased rate of ROSC and the improvement in metabolic state, whilst others talk of the increase in mortality and worsening of intracellular acidosis.

A recent paper in Resuscitation looked at a huge cohort of patients receiving bicarbonate in arrest prehospitally. In this episode we take a look at the paper, review the guidelines and give our take on the current situation with regards bicarb in arrest

We hope you enjoy it and would love to hear your feedback!

Simon & Rob

References & Further Reading

Prehospital Sodium Bicarbonate Use Could Worsen Long Term Survival with Favorable Neurological Recovery among Patients with Out-of-Hospital Cardiac Arrest. Kawano T, et al. Resuscitation. 2017

Use of Sodium Bicarbonate in Cardiac Arrest: Current Guidelines and Literature. Velissaris D, et al. J Clin Med Res. 2016

Effect of Sodium Bicarbonate on Advanced Cardiac Life Support. Jungyoup Lee. Circulation 2014

Advanced Life Support; Bicarbonate guidance

Transcript

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0:00.0	Welcome to the Recess Room podcast.
0:03.9	Five, four, three, two, one, fire.
0:12.8	So hi and welcome back to the Recess Room podcast.
0:16.6	I'm Simon Lang.
0:18.1	And I'm Rob Fenwick.
0:19.2	And this is another of our topics.
0:23.4	Ooh, drum roll what we got this month.
0:25.4	Well we haven't had one of these for a little while.
0:27.6	Roadside Teresa has been occupying our airspace a fair amount and it will continue to do so.
0:33.3	But I thought it was time we came back with another topic just as a added bonus.
0:37.6	So we're going to be covering sodium bicarbonate in the context of cardiac arrest.
0:44.7	Really? Sodium bicarbonate? In cardiac arrest? Yeah, I can maybe think of a couple of times that I'd give that.
0:51.9	But okay, yeah, let's discuss it. discuss it let's go further okay so I was brought up back in the day seeing a lot of cardiac rests actually getting
1:03.1	salient bicarbonate and I'd say the tendency has moved away from that practice but it
1:09.6	definitely hasn't gone.
1:13.3	I've certainly been around rest in the last few years where sodium bicarbonate is discussed a lot and has definitely been given.
1:18.6	Oh yeah, absolutely. Yeah, I can, in fact, in the last month or so,
1:22.1	I think I've seen at least one arrest where it's been given.
1:25.0	And yeah, it would be good to discuss a little bit more around
1:27.4	why we're giving it and what we're giving it for. Okay, well, theoretically, sodium bicarbonate
1:33.1	makes sense, doesn't it? So perfect sense. Especially those patients that are in an arrest in which
1:38.8	they have a severe metabolic acidosis. So we know an acidosis is bad for lots of cellular functions.
	...

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