Improved resuscitation outcome in emergency medical systems with increased usage of sodium bicarbonate during cardiopulmonary resuscitation

医学 碳酸氢钠 心肺复苏术 肾上腺素 复苏 碳酸氢盐 麻醉 随机对照试验 急诊医学 内科学 物理化学 化学
作者
Gad Bar‐Joseph,Norman S. Abramson,Sheryl F. Kelsey,Tatiania Mashiach,Mary Craig,Peter Šafář
出处
期刊:Acta Anaesthesiologica Scandinavica [Wiley]
卷期号:49 (1): 6-15 被引量:95
标识
DOI:10.1111/j.1399-6576.2005.00572.x
摘要

Background: The use of sodium bicarbonate (SB) in cardiopulmonary resuscitation (CPR) is controversial. This study analyzes the effects of SB use on CPR outcome in the Brain Resuscitation Clinical Trial III (BRCT III), which was a multicenter randomized trial comparing high‐dose to standard‐dose epinephrine during CPR. Sodium bicarbonate use in BRCT III was optional. Methods: The entire BRCT III database was reviewed. Analysis included only patients who arrested out of the hospital and whose time from collapse to initiation of ACLS was no longer than 30 min (total n = 2122 patients). Sodium bicarbonate use by the 16 participating study sites was analyzed. The study sites were divided according to their SB usage profile: ‘low SB user’ sites administered SB in less than 50% of CPRs and their first epinephrine to SB time exceeded 10 min; and ‘high SB user’ sites used SB in over 50% of CPRs and their first epinephrine to SB time was <10 min. Results: Sites' SB usage rates ranged between 3.1% and 98.2% of CPRs. Sodium bicarbonate usage rates correlated inversely with the sites' intervals from collapse ( r = − 0.579 P = 0.018) from initiation of ACLS ( r = − 0.685 P = 0.003) and from first epinephrine ( r = − 0.611 P = 0.012) to SB administration. Mean ROSC rate in the ‘high SB user’ sites was 33.5% (CI = 30.0–37.0) compared to 25.7% (CI = 23.1–28.4) in the ‘low SB user’ sites. In the ‘high SB user’ sites, hospital discharge rate was 5.3% (CI = 3.6–7.0) compared to 3% (CI = 2.0–4.0) in the ‘low SB user’ sites, and 5.3% (CI = 3.6–7.0) had a favorable neurological outcome compared to 2.1% (CI = 1.2–3.0) in the ‘low SB user’ sites. Collapse to ACLS interval was 8.5 min (CI = 8.1–9.0) in the ‘high SB user’ sites compared to 10.2 min (CI = 9.8–10.6) in the ‘low SB user’ sites, and their ACLS to first epinephrine interval was 7.0 min (CI = 6.5–7.5) compared to 9.7 min (CI = 9.3–10.2). Multivariate regression analysis found that belonging to ‘high SB user’ sites independently increased the chances for ROSC (OR 1.36, CI 1.08–1.7) and for achieving a good neurological outcome (OR 2.18, CI 1.23–3.86). Conclusions: Earlier and more frequent use of SB was associated with higher early resuscitability rates and with better long‐term outcome. Sodium bicarbonate may be beneficial during CPR, and it should be subjected to a randomized clinical trial.
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