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February 2, 1976

Sodium Bicarbonate Administration During Cardiac Arrest: Effect on Arterial pH, Pco2, and Osmolality

Author Affiliations

From the Peter Belfer Laboratory for Myocardial Research and the Cardiovascular Division, Johns Hopkins University School of Medicine, Baltimore. Dr Weisfeldt was an Established Investigator of the American Heart Association. Dr Bishop is now with the University of Massachusetts Medical School, Worchester.

JAMA. 1976;235(5):506-509. doi:10.1001/jama.1976.03260310020014

Arterial pH, Pco2, and osmolality were determined serially during cardiac resuscitation in patients and in dogs, with and without administration of sodium bicarbonate. These studies demonstrate that (1) in the absence of preexisting acidosis, severe acidosis can be prevented by adequate ventilation alone; (2) sodium bicarbonate administration results in a significant rise in arterial Pco2, which parallels the rise in pH despite adequate ventilation; (3) during prolonged cardiac arrest and resuscitation, there is a rise in arterial osmolality that is accentuated by sodium bicarbonate. These studies suggest that sodium bicarbonate should not be used during resuscitation (1) in the absence of effective hyperventilation or where carbon dioxide removal is inadequate despite adequate ventilation, (2) in repeated doses, without confirmation of substantial acidosis, or (3) when cardiac arrest has been of brief duration and preexisting acidosis is unlikely. These studies also point to the need for a reappraisal of other buffers that do not elevate the arterial Pco2.

(JAMA 235:506-509, 1976)