• Takahisa Kawano, Brian Grunau, Frank X Scheuermeyer, Koichiro Gibo, William Dick, Christopher B Fordyce, Paul Dorian, Robert Stenstrom, Ronald Straight, and Jim Christenson.
• The Department of Emergency Medicine, St. Paul's Hospital, Vancouver, BC, Canada; The Department of Emergency Medicine, University of Fukui Hospital, Fukui Prefecture, Japan. Electronic address: Takahisa.Kawano@ubc.ca.
• Resuscitation. 2017 Oct 1; 119: 63-69.

BackgroundSodium bicarbonate (SB) is widely used for resuscitation in out-of- hospital cardiac arrest (OHCA); however, its effect on long term outcomes is unclear.MethodsFrom 2005-2016, we prospectively conducted a province-wide population-based observational study including adult non-traumatic OHCA patients managed by paramedics. SB was administered by paramedics based on their clinical assessments. To examine the association of SB administration and survival and favorable neurological outcome to hospital discharge, defined as modified Rankin scale of 3 or less, we performed a multivariable logistic regression analysis: (1) within propensity score matched comparison groups, and; (2) within the full cohort with missing variables addressed by multiple imputation techniques.ResultsOf 15 601 OHCA patients, 13,865 were included in this study with 5165 (37.3%) managed with SB. In the SB treated group, 118 (2.3%) patients survived and 62 (1.2%) had favorable neurological outcomes to hospital discharge, compared to 1699 (19.8%) and 831 (10.6%) in the non-SB treated group, respectively. In the 1:1 propensity matched cohort including 5638 OHCA patients, SB was associated with decreased probability of outcomes (adjusted OR for survival: 0.64, 95% CI 0.45-0.91, and adjusted OR for favorable neurological outcome: 0.59, 95% CI 0.39-0.88, respectively). The association remained consistent in the multiply imputed cohort (adjusted OR 0.48, 95 CI 0.36-0.64, and adjusted OR 0.54, 95% CI 0.38-0.76, respectively).ConclusionsIn OHCA patients, prehospital SB administration was associated with worse survival rate and neurological outcomes to hospital discharge.Copyright © 2017 Elsevier B.V. All rights reserved.

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