Prove It: Is sodium bicarbonate indicated for prolonged cardiac arrest?

Research suggests an association between sodium bicarbonate and decreased survival-to-hospital discharge and worsened neurological status


Sodium bicarbonate case review: Medic 34 and Engine 3 respond to a report of an unconscious person. The engine arrives first and notifies the responding medic that CPR is in progress.

The medics arrive to find a 68-year-old male lying in a bedroom floor. The patient’s wife said she was out of the house most of the day. When she arrived home, she found her unresponsive husband lying in the bed. He had a heart attack about 10 years ago and had some type of “heart cath” procedure. He takes medications for hypertension, high cholesterol, and an aspirin each day.

The firefighters report they found the man lying unresponsive on the bed. They moved him to the floor and began CPR. They attached the AED, which twice advised that no shock was indicated.

After attaching the ECG monitor, the initial rhythm is asystole. There is easy IV access in the patient’s left arm and Medic Hernandez administers epinephrine. Medic Thompson easily intubates the patient’s trachea on the first attempt, hears bilateral lung sounds, and sees a capnography waveform on the monitor with a reading of 10 mmHg.

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