To the Editor.
—I read with interest the editorial by Weisfeldt and Guerci1 regarding the use of sodium bicarbonate in cardiopulmonary resuscitation (CPR). I agree with their general assertion that sodium bicarbonate plays no major role in routine CPR.However, I do feel that in the case of the chronic dialysis patient who presents either in the field or to the emergency department with a life-threatening arrhythmia, that bicarbonate should almost invariably be one of the first drugs used. As the authors mention, sodium bicarbonate is used for potential hyperkalemia.Commonly, we see patients who have had a long weekend of 3 days or so, who are volume overloaded, hyperkalemic, and acidotic who either arrest at home, on the way to the hospital, or shortly after presenting to the emergency department or the dialysis unit. In my experience, mere CPR is invariably not as successful as first giving the
Evans DH. Presumptive Use of Bicarbonate in Cardiopulmonary Resuscitation. JAMA. 1992;267(6):807. doi:10.1001/jama.1992.03480060053024