As you may recall, you may patch to a BHP to consider administering sodium bicarbonate.​

The evidence for using sodium bicarbonate outlined by the AHA (2020) are in the following scenarios:​

1. Cardiac arrest due to known or suspected hyperkalemia and other causes of acidosis​
2. Cardiac conduction delays due to sodium channel blocker/tricyclic antidepressant (TCA) overdose​

Let’s review these a little bit further

Potential Benefit: HyperK ​

Consider patching for sodium bicarbonate when Hyperkalemia is a known or suspected cause of arrest (think: missed dialysis, for example).​

• In addition to IV calcium & salbutamol ​
• Aim to rapidly correct acidemia

Potential Benefit: Other Acidosis Causes​

• Potential causes of acidosis that can lead to cardiac arrest (and prompt consideration to patch for bicarb):​
  • Sepsis​
  • Diabetic Ketoacidosis ​
  • Excited Delirium ​
  • ROSC with Re-arrest​

Note: Acidemia is a dynamic process which is best managed by high-quality CPR, early defibrillation, and an additional benefit of ventilation.

Potential Benefit: Na Channel Blockers ​

In the setting of Sodium Channel Blocker overdose with a widened QRS, consider patching for sodium bicarbonate (either in cardiac arrest OR peri-arrest). ​

• Aim is to “out-compete” the sodium blockers​

Examples of Sodium Channel Blockers to consider:​

• Acute cocaine toxicity​
• Doxepin​
• Wellbutrin​
• Phenytoin​
• Carbamazepine​
• Tricyclic Antidepressants

Potential Risks

The AHA (2020) guidelines does not recommend the routine use of sodium bicarbonate for patients in cardiac arrest:​

• There is no evidence for improved outcomes​
• Evidence suggests it may worsen survival and neurological recovery​

Additional risks associated: ​

• Hypernatremia​
• Hyperosmolality​
• Intracellular acidosis ​
• Extracellular alkalosis​
• Reduced cardiac output​
• Inactivation of catecholamines (administered simultaneously)

Bottom Line​

Consideration for the administration of sodium bicarbonate is multifactorial – there are some potential benefits and associated risks. A BHP patch is required.​

Now you know the evidence-backed reasons to call and why you may or may not receive the order!

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