Sodium Bicarbonate 50 mEq/50 mL is mandated to be carried by ACPs per the Equipment Standards, however it is not written into the Treatments sections of the ALS-PCS. ​

Therefore, administering sodium bicarbonate is outside the scope of the Medical Directives and requires a patch to the Base Hospital Physician.​

Let’s briefly review Bicarb and when to consider patching for it!

AHA (2020) Recommendations:​

The AHA Guidelines for CPR and ECC (2020) suggest evidence for use of sodium bicarbonate in the following:​

• Special situations of cardiac arrest:​
  • Known or suspected hyperkalemia ​
  • Other causes of acidosis (a separate post on this, later!)​
• Cardiac conduction delays due to sodium channel blocker or tricyclic antidepressant (TCA) overdose:​
  • Signs include widened QRS on ECG​
  • The patient does not need to be in cardiac arrest!

Background​

• Alkalinzing agent; Electrolyte supplement​
• Ongoing debate regarding potential benefit vs. harm in cardiac arrest management​
• Frequency of use varies greatly between medical centers and between clinicians​
• Administration is advised at the discretion of the physician directing the resuscitation

​AHA (2020) Recommendations cont’d:​

No evidence for use in routine, undifferentiated cardiac arrest:​

• AHA recommends against sodium bicarbonate in this case​
• There is no evidence for improved outcomes​
• Evidence suggests it may worsen survival and neurological recovery

Bottom Line​

Consideration for the administration of sodium bicarbonate is multifactorial – a BHP Patch is required to administer. ​

Consider patching for the evidence-supported times to administer sodium bicarbonate!

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