• Maxime Touron, François Javaudin, Quentin Lebastard, Valentine Baert, Mathieu Heidet, Hervé Hubert, Brice Leclere, LascarrouJean-BaptisteJBMedecine Intensive Reanimation, Nantes University Hospital.AfterROSC Network.Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France., and RéAC Network.
• Medecine Intensive Reanimation, Nantes University Hospital.
• Eur J Emerg Med. 2022 Jun 1; 29 (3): 210220210-220.

Background And ImportanceNo large randomised controlled trial has assessed the potential benefits on neurologic outcomes of prehospital sodium bicarbonate administration in patients with nontraumatic out-of-hospital cardiac arrest (OHCA).ObjectiveTo obtain information of assistance in designing a randomised controlled trial of bicarbonate therapy after OHCA in specific patient subgroups.DesignWe conducted two, separate, simultaneous, retrospective studies of two distinct, unlinked datasets.Setting And ParticipantsOne dataset was a French nationwide population-based registry (RéAC Registry, French dataset) and the other was a randomised controlled trial comparing continuous to interrupted chest compressions in North America (ROC-CCC trial, North-American dataset).InterventionWe investigated whether prehospital bicarbonate administration was associated with better neurologic outcomes.Outcome Measures And AnalysesThe main outcome measure was the functional outcome at hospital discharge. To adjust for potential confounders, we conducted a nested propensity-score-matched analysis with inverse probability-of-treatment weighting.Main ResultsIn the French dataset, of the 54 807 patients, 1234 (2.2%) received sodium bicarbonate and 450 were matched. After propensity-score matching, sodium bicarbonate was not associated with a higher likelihood of favourable functional outcomes on day 30 [adjusted odds ratio (aOR), 0.912; 95% confidence interval (95%CI), 0.501-1.655]. In the North-American dataset, of the 23 711 included patients, 4902 (20.6%) received sodium bicarbonate and 1238 were matched. After propensity-score matching, sodium bicarbonate was associated with a lower likelihood of favourable functional outcomes at hospital discharge (aOR, 0.45; 95% CI, 0.34-0.58).ConclusionIn patients with OHCA, prehospital sodium bicarbonate administration was not associated with neurologic outcomes in a French dataset and was associated with worse neurologic outcomes in a North-American dataset. Given the considerable variability in sodium bicarbonate use by different prehospital care systems and the potential resuscitation-time bias in the present study, a large randomised clinical trial targeting specific patient subgroups may be needed to determine whether sodium bicarbonate has a role in the prehospital management of prolonged OHCA.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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