Abstract 321: Sodium Bicarbonate Use During In-hospital Pediatric Cardiopulmonary Resuscitation - A Report From the American Heart Association Get With The Guidelines-Resuscitation®

Abstract

OBJECTIVES: The 2005 and 2010 Pediatric Advanced Life Support (PALS) Guidelines do not recommend using sodium bicarbonate (SB) during cardiopulmonary resuscitation (CPR) except for select resuscitation situations. We hypothesize that SB is used frequently during in-hospital pediatric CPR and its use is associated with worse survival to hospital discharge when given outside of these recommended resuscitation situations. PATIENTS AND METHODS: We analyzed data from 8602 consecutive pediatric CPR events (patients < 18 yrs) submitted to the American Heart Association Get With The Guidelines-Resuscitation from January 2000 through September 2010. The primary outcome was survival to hospital discharge. Secondary outcomes included event survival, 24 hr survival, and neurologic outcome. Multivariable logistic regression was performed to analyze the association between SB use and outcomes. RESULTS: SB was used in 3923 (46%) of 8602 events. The incidence of SB use between 2000-2005 vs. 2006-2010 was 54% vs. 41% (p <0.001; Fig. 1). After adjustment for confounding factors (e.g. event location, illness category, arrest rhythm, concurrent advanced cardiac life support medications, and duration of CPR > 15 mins), the use of SB during CPR was associated with decreased survival to discharge (OR: 0.62; 95% CI: 0.54, 0.71), but not unfavorable neurologic outcome (OR 0.73; 95% CI 0.50, 1.05). In the settings of metabolic/electrolyte abnormalities, toxicologic abnormalities/overdose /poisoning, and high potassium, SB use during CPR was not associated with worse survival to discharge (OR: 0.78; 95% CI: 0.56; 1.09) or unfavorable neurologic outcome (OR 1.05; 95% CI: 0.37, 2.97). After excluding patients in the settings of metabolic/electrolyte abnormalities, toxicologic abnormalities, and hyperkalemia, SB use during CPR (n = 5270) continued to be associated with worse survival to discharge (OR: 0.61; 95% CI: 0.53, 0.71) and unfavorable neurologic outcome (OR: 0.64; 95% CI: 0.43, 0.95). CONCLUSIONS: Sodium bicarbonate continues to be used frequently during in-hospital pediatric CPR, yet there is a significant trend towards less routine use over the last decade. Sodium bicarbonate use is associated with decreased survival to hospital discharge and unfavorable neurologic outcome when given outside PALS recommendations.