• Katherine Cashen, Ron W Reeder, Tageldin Ahmed, Michael J Bell, Robert A Berg, Candice Burns, Joseph A Carcillo, Todd C Carpenter, J Michael Dean, J Wesley Diddle, Myke Federman, Ericka L Fink, Aisha H Frazier, Stuart H Friess, Kathryn Graham, Mark Hall, David A Hehir, Christopher M Horvat, Leanna L Huard, Tensing Maa, Arushi Manga, Patrick S McQuillen, Ryan W Morgan, Peter M Mourani, Vinay M Nadkarni, Maryam Y Naim, Daniel Notterman, Chella A Palmer, Murray M Pollack, Carleen Schneiter, Matthew P Sharron, Neeraj Srivastava, David Wessel, Heather A Wolfe, Andrew R Yates, Athena F Zuppa, Robert M Sutton, Kathleen L Meert, and for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN) and .
• Department of Pediatrics, Duke Children's Hospital, Duke University, Durham, NC.
• Pediatr Crit Care Me. 2022 Oct 1; 23 (10): 784792784-792.

ObjectivesTo evaluate associations between sodium bicarbonate use and outcomes during pediatric in-hospital cardiac arrest (p-IHCA).DesignPrespecified secondary analysis of a prospective, multicenter cluster randomized interventional trial.SettingEighteen participating ICUs of the ICU-RESUScitation Project (NCT02837497).PatientsChildren less than or equal to 18 years old and greater than or equal to 37 weeks post conceptual age who received chest compressions of any duration from October 2016 to March 2021.InterventionsNone.Measurements And Main ResultsChild and event characteristics, prearrest laboratory values (2-6 hr prior to p-IHCA), pre- and intraarrest hemodynamics, and outcomes were collected. In a propensity score weighted cohort, the relationships between sodium bicarbonate use and outcomes were assessed. The primary outcome was survival to hospital discharge. Secondary outcomes included return of spontaneous circulation (ROSC) and survival to hospital discharge with favorable neurologic outcome. Of 1,100 index cardiopulmonary resuscitation events, median age was 0.63 years (interquartile range, 0.19-3.81 yr); 528 (48.0%) received sodium bicarbonate; 773 (70.3%) achieved ROSC; 642 (58.4%) survived to hospital discharge; and 596 (54.2%) survived to hospital discharge with favorable neurologic outcome. Among the weighted cohort, sodium bicarbonate use was associated with lower survival to hospital discharge rate (adjusted odds ratio [aOR], 0.7; 95% CI, 0.54-0.92; p = 0.01) and lower survival to hospital discharge with favorable neurologic outcome rate (aOR, 0.69; 95% CI, 0.53-0.91; p = 0.007). Sodium bicarbonate use was not associated with ROSC (aOR, 0.91; 95% CI, 0.62-1.34; p = 0.621).ConclusionsIn this propensity weighted multicenter cohort study of p-IHCA, sodium bicarbonate use was common and associated with lower rates of survival to hospital discharge.Copyright © 2022 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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