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October 16, 1991, Vol 266, No. 15 >
ARTICLE | October 16, 1991

Sodium Bicarbonate in CPR FREE

Myron L. Weisfeldt, MD; Alan D. Guerci, MD
[+] Author Affiliations

Reprint requests to Department of Medicine, Columbia Presbyterian Medical Center, 630 W 168th St, New York, NY 10032 (Dr Weisfeldt).


JAMA. 1991;266(15):2129-2130. doi:10.1001/jama.1991.03470150101039
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References

Metabolic and respiratory acidosis decreases myocardial contractility and inhibits the cardiovascular response to catecholamines.1-3 Because of these adverse effects, and because of the relative ease with which the arterial acidemia of cardiac arrest can be reversed with sodium bicarbonate, sodium bicarbonate was quickly incorporated into the pharmacopoeia of resuscitation.4

The study by Kette et al5 published in this issue of The Journal is an important additional piece of evidence against the routine use of sodium bicarbonate in cardiac arrest. Their findings are important, but not particularly surprising. In 1974, Mattar et al6 reported that hyperosmolality occurring as a result of the administration of commercially available preparations of sodium bicarbonate, which contain either 1792 or 2000 mOsm/L, was an independent risk factor for in-hospital death following initially successful resuscitation.

The rationale for the use of sodium bicarbonate in cardiac arrest is to correct

REFERENCES

1 +
Cingolani HE, Faulkner SL, Mattiazzi AR, Bender HW, Graham TP.  Depression of human myocardial contractility with 'respiratory' and 'metabolic' acidosis. Surgery . 1975;;77:427-432.
2 +
Orchard CH, Kentish JC.  Effects of changes of pH on the contractile function of cardiac muscle, part I. Am J Physiol . 1990;;258;C967-C981.
3 +
Andersen MN, Border JR, Mouritzen CV.  Acidosis, catecholamines, and cardiovascular dynamics: when does acidosis require correction? Ann Surg . 1967;;166:344-356.
4 +
 Standards and guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC). JAMA . 1986;;255:2905-2989.
5 +
Kette F, Weil MH, Gazmuri RJ.  Buffer solutions may compromise cardiac resuscitation by reducing coronary perfusion pressure. JAMA . 1991;;266:2121-2126.
6 +
Mattar JA, Neil MH, Shubin H, Stein L.  Cardiac arrest in the critically ill, II: hyperosmolal states following cardiac arrest. Am J Med . 1974;;56:162-168.
7 +
Weisfeldt ML, Bishop RL, Greene HL.  Effects of pH and PCO2 on performance of ischemic myocardium.  In: Dhalla NS, Ronag G, eds. Recent Advances in Studies on Cardiac Structure and Metabolism . Baltimore, Md: University Park Press; 1975;;10:355-364.
8 +
Khuri SF, Flaherty JT, O'Riordan JB, et al.  Changes in intramyocardial ST segment voltage and gas tensions with regional myocardial ischemia in the dog. Circ Res . 1975;;37:455-462.
9 +
Bishop AL, Weisfeldt ML.  Sodium bicarbonate administration during cardiac arrest: effect on arterial pH, PCO2, and osmolality. JAMA . 1976;;235:506-509.
10 +
Telivuo L, Maamies J, Siltanen P, Tala P.  Comparison of alkalinizing agents in resuscitation of the heart after ventricular fibrillation. Ann Chir Gynaecol Fenniae . 1968;;57:221-224.
11 +
Minuck M, Sharma GP.  Comparison of THAM and sodium bicarbonate in resuscitation of heart after ventricular fibrillation in dogs. Anesth Analg . 1977;;56:38-45.
12 +
Guerci AD, Chandra N, Johnson E, et al.  Failure of sodium bicarbonate to improve resuscitation from ventricular fibrillation in dogs. Circulation . 1986;;74( (suppl IV) ):IV-75-IV-79.
13 +
Kette F, Weil MH, von Planta M, Gazmuri RJ, Rackow EC.  Buffer agents do not reverse intramyocardial acidosis during cardiac resuscitation. Circulation . 1990;;81:1660-1666.
14 +
Gazmuri RJ, von Planta M, Weil MH, Rackow EC.  Cardiac effects of carbon dioxide—consuming and carbon dioxide—generating buffers during cardiopulmonary resuscitation. J Am Coll Cardiol . 1990;;15:482-490.
15 +
Ichihara H, Haka N, Abiko Y.  Is ischemia-induced pH decrease of dog myocardium respiratory or metabolic acidosis? Am J Physiol . 1984;;246:H652-H657.
16 +
Von Planta M, Gudipati C, Weil MH, Kraus LJ, Rackow EC.  Effects of tromethamine and sodium bicarbonate buffers during cardiac resuscitation. J Clin Pharmacol . 1988;;28:594-599.
17 +
Filley GF, Kindig NB.  Carbicarb, an alkalinizing ion-generating agent of possible clinical usefulness. Trans Am Clin Climatol Assoc . 1984;;96:141-153.
18 +
Swenson RD, Weaver WD, Niskanen RA, Martin J, Dahlberg S.  Hemodynamics in humans during conventional and experimental methods of cardiopulmonary resuscitation. Circulation . 1988;;78:630-639.
19 +
Paradis N, Martin GB, Rivers EP, et al.  Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation. JAMA . 1990;;263:1106-1113.
20 +
Gonzales ER, Ornato JP, Garnett AR, Levine R, Young DS, Racht EM.  Dose-dependent vasopressor response to epinephrine during CPR in human beings. Ann Emerg Med . 1989;;18:920-926.
21 +
Sanders AB, Ewy GA, Taft TV.  The prognostic and therapeutic importance of the aortic diastolic pressure in resuscitation from cardiac arrest. Crit Care Med . 1984;;12:871-873.

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1 +
Cingolani HE, Faulkner SL, Mattiazzi AR, Bender HW, Graham TP.  Depression of human myocardial contractility with 'respiratory' and 'metabolic' acidosis. Surgery . 1975;;77:427-432.
2 +
Orchard CH, Kentish JC.  Effects of changes of pH on the contractile function of cardiac muscle, part I. Am J Physiol . 1990;;258;C967-C981.
3 +
Andersen MN, Border JR, Mouritzen CV.  Acidosis, catecholamines, and cardiovascular dynamics: when does acidosis require correction? Ann Surg . 1967;;166:344-356.
4 +
 Standards and guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC). JAMA . 1986;;255:2905-2989.
5 +
Kette F, Weil MH, Gazmuri RJ.  Buffer solutions may compromise cardiac resuscitation by reducing coronary perfusion pressure. JAMA . 1991;;266:2121-2126.
6 +
Mattar JA, Neil MH, Shubin H, Stein L.  Cardiac arrest in the critically ill, II: hyperosmolal states following cardiac arrest. Am J Med . 1974;;56:162-168.
7 +
Weisfeldt ML, Bishop RL, Greene HL.  Effects of pH and PCO2 on performance of ischemic myocardium.  In: Dhalla NS, Ronag G, eds. Recent Advances in Studies on Cardiac Structure and Metabolism . Baltimore, Md: University Park Press; 1975;;10:355-364.
8 +
Khuri SF, Flaherty JT, O'Riordan JB, et al.  Changes in intramyocardial ST segment voltage and gas tensions with regional myocardial ischemia in the dog. Circ Res . 1975;;37:455-462.
9 +
Bishop AL, Weisfeldt ML.  Sodium bicarbonate administration during cardiac arrest: effect on arterial pH, PCO2, and osmolality. JAMA . 1976;;235:506-509.
10 +
Telivuo L, Maamies J, Siltanen P, Tala P.  Comparison of alkalinizing agents in resuscitation of the heart after ventricular fibrillation. Ann Chir Gynaecol Fenniae . 1968;;57:221-224.
11 +
Minuck M, Sharma GP.  Comparison of THAM and sodium bicarbonate in resuscitation of heart after ventricular fibrillation in dogs. Anesth Analg . 1977;;56:38-45.
12 +
Guerci AD, Chandra N, Johnson E, et al.  Failure of sodium bicarbonate to improve resuscitation from ventricular fibrillation in dogs. Circulation . 1986;;74( (suppl IV) ):IV-75-IV-79.
13 +
Kette F, Weil MH, von Planta M, Gazmuri RJ, Rackow EC.  Buffer agents do not reverse intramyocardial acidosis during cardiac resuscitation. Circulation . 1990;;81:1660-1666.
14 +
Gazmuri RJ, von Planta M, Weil MH, Rackow EC.  Cardiac effects of carbon dioxide—consuming and carbon dioxide—generating buffers during cardiopulmonary resuscitation. J Am Coll Cardiol . 1990;;15:482-490.
15 +
Ichihara H, Haka N, Abiko Y.  Is ischemia-induced pH decrease of dog myocardium respiratory or metabolic acidosis? Am J Physiol . 1984;;246:H652-H657.
16 +
Von Planta M, Gudipati C, Weil MH, Kraus LJ, Rackow EC.  Effects of tromethamine and sodium bicarbonate buffers during cardiac resuscitation. J Clin Pharmacol . 1988;;28:594-599.
17 +
Filley GF, Kindig NB.  Carbicarb, an alkalinizing ion-generating agent of possible clinical usefulness. Trans Am Clin Climatol Assoc . 1984;;96:141-153.
18 +
Swenson RD, Weaver WD, Niskanen RA, Martin J, Dahlberg S.  Hemodynamics in humans during conventional and experimental methods of cardiopulmonary resuscitation. Circulation . 1988;;78:630-639.
19 +
Paradis N, Martin GB, Rivers EP, et al.  Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation. JAMA . 1990;;263:1106-1113.
20 +
Gonzales ER, Ornato JP, Garnett AR, Levine R, Young DS, Racht EM.  Dose-dependent vasopressor response to epinephrine during CPR in human beings. Ann Emerg Med . 1989;;18:920-926.
21 +
Sanders AB, Ewy GA, Taft TV.  The prognostic and therapeutic importance of the aortic diastolic pressure in resuscitation from cardiac arrest. Crit Care Med . 1984;;12:871-873.

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