Some studies have shown evidence of benefit in out of hospital cardiac arrest or prolonged resuscitation, while some studies suggest that bicarbonate administration during cardiopulmonary resuscitation (CPR) may have adverse effects and any decision as to its use should be based on central venous blood gas estimations. The purpose of this study was to find out whether bicarbonate administration was associated with any difference in survival.
Method: A total of 935 in-hospital codes which occurred between March 2003 and July 2008 were reviewed. Inclusion criteria were: In-hospital CPR and age greater than 18 years. The following data were extracted from each of the codes: a) Patient demographics, b) Co-morbid conditions, c) Primary arrest rhythm, d) Blood gas analysis, e) bicarbonate administration, and f) outcome of the code. Data analysis was done using Systat version 12.
Results: 53% of patients had blood gas analysis during the code. However, only 32% of codes had clear documentation about bicarbonate use, out of which 69% received intravenous bicarbonate during the code. There was no significant difference in outcome between patients who had blood gas analysis during the code and those who did not. However, intravenous bicarbonate was associated with statistically significant increase in survival (OR = 3.43, P < 0.001). Of the 20 different groups of co-morbid conditions analyzed, only renal disease (P = 0.027), cancer (P = 0.016), and heart disease (0.036) significantly affected outcome and all were associated with increased mortality.
Conclusion: Bicarbonate administration was associated with an increased resuscitation rate. Blood gas analysis does not appear to have any positive impact on the successful outcome of cardiopulmonary resuscitation.Further studies to look at duration of in-hospital code and the impact of bicarbonate and correlation with blood gas analysis result should be considered.
Clinical: Bicarbonate administration should be considered during in-hospital CPR.
Kennedy Eneh, No Financial Disclosure Information; No Product/Research Disclosure Information