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Xu T, Wu C, Shen Q, Xu H, Huang H. The effect of sodium bicarbonate on OHCA patients: A systematic review and meta-analysis of RCT and propensity score studies. Am J Emerg Med 2023; 73:40-46. [PMID: 37611525 DOI: 10.1016/j.ajem.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Evidence on the efficacy of sodium bicarbonate (SB) in out-of-hospital cardiac arrest (OHCA) is controversial and generally of low quality. A systematic review and meta-analysis was performed to evaluate the effect of SB in OHCA patients based on randomized controlled trial (RCT) and propensity score matching (PSM) cohort studies. METHODS We searched the PubMed, Cochrane, and Embase databases for RCTs and PSM cohort studies from inception to July 15, 2023. We included studies involving adult (>16 years) no-trauma OHCA patients with clear comparisons between the Bicarbonate group and Control group. All studies reported our primary outcome of short-term survival rate included ROSC and survival to emergency department or hospital admission or secondary outcome of long-term survival rate included survival at hospital discharge and good neurologic survival at 1 month. Results were expressed as odds ratio (OR) with accompanying 95% confidence interval (CI). To reduce bias, we performed a subgroup analysis of RCTs and PSM cohort studies. Also, we performed sensitivity analysis to resolve the heterogeneity. RESULTS Six studies (3 RCTs and 3 PSMs) comprising 21,402 patients were included. The primary outcome of this meta-analysis showed that short-term survival rate between the two groups was no difference (OR = 1.04; 95% CI, 0.98 to 1.12; P = 0.21; χ2 = 6.68; I2 = 25%). Secondary outcome demonstrated that long -term survival rate between the two groups was no difference (OR = 0.82; 95% CI, 0.50 to 1.34; P = 0.43; χ2 = 14.96; I2 = 80%). A sensitive analysis was performed by removing one study showed long-term survival rate of the Bicarbonate group was lower than that of the Control group. CONCLUSIONS In patients with OHCA, sodium bicarbonate administration was associated neither with short-term survival rate nor with long-term survival rate, it may even worsen the long-term survival.
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Affiliation(s)
- Tingzhen Xu
- Department of Emergency, The First Affiliated Hospital of Zhejiang Chinese Medical University/Zhejiang Provincial Hospital of Traditional Chinese Medicine, Zhejiang 310018, Hangzhou, China
| | - Chenxia Wu
- Department of Emergency, The First Affiliated Hospital of Zhejiang Chinese Medical University/Zhejiang Provincial Hospital of Traditional Chinese Medicine, Zhejiang 310018, Hangzhou, China
| | - Qinkang Shen
- Department of Emergency, The First Affiliated Hospital of Zhejiang Chinese Medical University/Zhejiang Provincial Hospital of Traditional Chinese Medicine, Zhejiang 310018, Hangzhou, China
| | - Hua Xu
- Department of Emergency, The First Affiliated Hospital of Zhejiang Chinese Medical University/Zhejiang Provincial Hospital of Traditional Chinese Medicine, Zhejiang 310018, Hangzhou, China.
| | - Haijun Huang
- Department of Emergency, The First Affiliated Hospital of Zhejiang Chinese Medical University/Zhejiang Provincial Hospital of Traditional Chinese Medicine, Zhejiang 310018, Hangzhou, China.
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Albano J, Conner TM. Does sodium bicarbonate significantly improve survival in asystolic and PEA out-of-hospital cardiac arrest? Resuscitation 2023; 191:109884. [PMID: 37748822 DOI: 10.1016/j.resuscitation.2023.109884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 09/27/2023]
Affiliation(s)
- Jesse Albano
- Department of Pharmacy, Yale New Haven Health System, 20 York St., New Haven, CT 06510, USA.
| | - Todd M Conner
- Department of Pharmacy, Yale New Haven Health System, 20 York St., New Haven, CT 06510, USA
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Hsieh MS, Chattopadhyay A, Lu TP, Liao SH, Chang CM, Lee YC, Lo WE, Wu JJ, Hsieh VCR, Hu SY, How CK. Effect of end-stage kidney disease on the return of spontaneous circulation in Taiwanese adults with out-of-hospital cardiac arrest. Sci Rep 2023; 13:7905. [PMID: 37193783 DOI: 10.1038/s41598-023-35024-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/11/2023] [Indexed: 05/18/2023] Open
Abstract
Rescuing patients with out-of-hospital cardiac arrest (OHCA), especially those with end-stage kidney disease (ESKD), is challenging. This study hypothesizes that OHCA patients with ESKD undergoing maintenance hemodialysis have (1) higher rates of return of spontaneous circulation (ROSC) during cardio-pulmonary resuscitation (CPR) and (2) lower rates of hyperkalemia and less severe acidosis than those without ESKD. OHCA patients who received CPR between 2011 and 2020 were dichotomized into ESKD and non-ESKD groups. The association of ESKD with "any" and "sustained" ROSC were examined using logistic regression analysis. Furthermore, the effect of ESKD on hospital outcomes for OHCA patients who survived to admission was evaluated using Kaplan-Meier analysis. ESKD patients without "any" ROSC displayed lower potassium and higher pH levels than non-ESKD patients. ESKD was positively associated with "any" ROSC (adjusted-OR: 4.82, 95% CI 2.70-5.16, P < 0.01) and "sustained" ROSC (adjusted-OR: 9.45, 95% CI 3.83-24.13, P < 0.01). Kaplan-Meier analysis demonstrated ESKD patients had a non-inferior hospital survival than non-ESKD patients. OHCA patients with ESKD had lower serum potassium level and less severe acidosis compared to the general population in Taiwan; therefore, should not be treated under the stereotypical assumption that hyperkalemia and acidosis always occur.
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Affiliation(s)
- Ming-Shun Hsieh
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Amrita Chattopadhyay
- Bioinformatics and Biostatistics Core, Center of Genomics and Precision Medicine, National Taiwan University, Taipei, Taiwan
| | - Tzu-Pin Lu
- Department of Public Health, National Taiwan University, Taipei, Taiwan
| | - Shu-Hui Liao
- Department of Pathology and Laboratory, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan
| | - Chia-Ming Chang
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, College of Public Health, Taipei, Taiwan
| | - Yi-Chen Lee
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan
| | - Wei-En Lo
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan
| | - Jia-Jun Wu
- Department of Critical Care Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan
| | - Vivian Chia-Rong Hsieh
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Sung-Yuan Hu
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Chorng-Kuang How
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Neth MR, Daya MR. Sodium bicarbonate therapy during out-of-hospital cardiac arrest: Is presenting rhythm the key to benefit? Resuscitation 2023; 182:109674. [PMID: 36581183 DOI: 10.1016/j.resuscitation.2022.109674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 12/15/2022] [Indexed: 12/27/2022]
Affiliation(s)
- Matthew R Neth
- Department of Emergency Medicine, Oregon Health and Science University, Mail Code: CDW-EM 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States
| | - Mohamud R Daya
- Department of Emergency Medicine, Oregon Health and Science University, Mail Code: CDW-EM 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States.
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