• Resuscitation · May 2021

    Review Meta Analysis

    Sodium bicarbonate administration during in-hospital pediatric cardiac arrest: a systematic review and meta-analysis.

    Routine administration of sodium bicarbonate during pediatric cardiac arrest is not recommended, and may in fact worsen survival.

    pearl
    • Chih-Yao Chang, Po-Han Wu, Cheng-Ting Hsiao, Chia-Peng Chang, Yi-Chuan Chen, and Kai-Hsiang Wu.
    • Department of Emergency Medicine, Chang Gung Memorial Hospital, No. 6, W. Sec., Jiapu Rd., Puzih City, Chiayi County 613, Taiwan.
    • Resuscitation. 2021 May 1; 162: 188-197.

    BackgroundCurrent American Heart Association Pediatric Life Support (PLS) guidelines do not recommend the routine use of sodium bicarbonate (SB) during cardiac arrest in pediatric patients. However, SB administration during pediatric resuscitation is still common in clinical practice. The objective of this study was to assess the impact of SB on mortality and neurological outcomes in pediatric patients with in-hospital cardiac arrest.MethodsWe searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials from inception to January 2021. We included studies of pediatric patients that had two treatment arms (treated with SB or not treated with SB) during in-hospital cardiac arrest (IHCA). Risk of bias was assessed using the Newcastle-Ottawa Scale and the certainty of evidence was assessed using GRADE system.ResultsWe included 7 observational studies with a total of 4877 pediatric in-hospital cardiac arrest patients. Meta-analysis showed that SB administration during pediatric cardiac resuscitation was associated with a significantly decreased rate of survival to hospital discharge (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.25-0.63, p value = 0.0003). There were insufficient studies for 24-h survival and neurologic outcomes analysis. The subgroup analysis showed a significantly decreased rate of survival to hospital discharge in both the "before 2010" subgroup (OR 0.47; 95% CI 0.30-0.73; p value = 0.006) and the "after 2010" subgroup (OR 0.46; 95% CI 0.25-0.87; p value = 0.02). The certainty of evidence ranged from very low to low.ConclusionsThis meta-analysis of non-randomized studies supported current PLS guideline that routine administration of SB is not recommended in pediatric cardiac arrest except in special resuscitation situations.Trial RegistrationThe protocol was registered with PROSPERO on 8 August 2020 (registration number: CRD42020197837).Copyright © 2021 Elsevier B.V. All rights reserved.

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    Routine administration of sodium bicarbonate during pediatric cardiac arrest is not recommended, and may in fact worsen survival.

    Daniel Jolley  Daniel Jolley
     
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