Sodium Bicarb in Cardiac Arrest

Sodium Bicarb in Cardiac Arrest: Over and Done?

July 1, 2022



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Matt Dillon, MD

ChristianaCare EM/IM, PGY-4
Twitter: @mdmd_8889
EMRA*Cast Episodes


Michael Perza, PharmD, BCPS

Emergency Medicine Clinical Pharmacist
ChristianaCare Health System, Newark, DE

Dustin Slagle, MD

EM/IM Resident, ChristianaCare 
EMRA Critical Care Committee Vice Chair, 2021-22

Some baked-in practices in medicine don't hold up to closer inspection. This episode of EMRA*Cast turns attention to the use of sodium bicarbonate in cardiac arrest. 

EMRA*Cast host Matt Dillon, MD, (@mdmd_8889) recently spoke with clinical ED pharmacist Mike Perza, PharmD, BCPS, (@pillpushermike) and future EMRA*Cast host, PGY-4 Dustin Slagle, MD, regarding sodium bicarbonate use during cardiac arrest and why you might want to think twice.

Take-Home Points

  • Bicarbonate use is still relatively common during cardiac arrest.
  • Although there are various indications for bicarb use, the evidence has not proven it to be beneficial in cardiac arrest.
  • Language in ACLS guidelines continues to move away from the use of bicarb, and the AHA “recommends against the routine use.”
  • Multiple retrospective studies, RCTs, and meta-analyses have failed to show improved outcomes.
  • The often-cited study that does purport a benefit has been controversial due to improper statistical application.
  • There exist multiple barriers to withholding bicarb, which include cultural and situational biases.


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