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Abstract
Systemic acidosis occurs during cardiac arrest and cardiopulmonary resuscitation (CPR).
The present study investigated the effect of different modes of sodium bicarbonate
administration on blood gas parameters during CPR. Arterial and venous blood gases
were obtained during 10 minutes of CPR which was preceded by 3 minutes of unassisted
ventricular fibrillation in 36 dogs. Following 1 minute of CPR, the animals received
one of four treatments in a randomized and blinded manner: normal saline (NS), sodium
bicarbonate bolus dose 1 mEq/kg (B), sodium bicarbonate continuous infusion 0.1 mEq/kg/min
(I), and sodium bicarbonate bolus dose (0.5 mEq/kg) plus continuous infusion 0.1 mEq/kg/min
(L + I). Eleven dogs completed NS, 8 B, 8 I, and 9 L + I protocol. Following NS infusion,
both arterial and venous pH declined consistently over time. Significant differences
compared with NS treatment in venous pH were observed at 12 minutes of ventricular
fibrillation (L + I, 7.27 ± 0.05; NS, 7.15 ± 0.05; B, 7.20 ± 0.05; I, 7.24 ± 0.04,
each bicarbonate treatment versus NS, and L + I versus B, (P < .05). The B group had an elevated venous PCO2 (mm Hg) concentration following 6 minutes of ventricular fibrillation compared with
NS, L + I, and I groups (81 ± 14 versus 69 ± 10 versus 68 ± 10 versus 71 ± 8, respectively,
(P = .07). Arterial pH and PCO2 values showed a similar trend as the venous data with the L + I group demonstrating
arterial alkalosis (pH > 7.45) at 12 minutes of ventricular fibrillation. The authors
conclude: (1) venous acidosis developed during NS treatment and worsened with duration
of CPR; (2) the L + I group showed significantly improved venous pH at 12 minutes
of ventricular fibrillation as compared with NS and B but at the expense of arterial
alkalosis; (3) the I group also had a greater effect on venous pH than the NS and
B groups, but without causing arterial alkalosis at 12 minutes of ventricular fibrillation;
and (4) a continuous infusion of sodium bicarbonate may be the most desirable mode
of administration for the prevention of venous acidosis during CPR; however arterial
alkalosis may occur when an additional small bolus dose of bicarbonate is administered.
Further studies are needed to determine if such dosing methods alter other clinical
outcome parameters.
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Article Info
Publication History
Accepted:
June 19,
1992
Received:
January 28,
1992
Footnotes
☆Presented in part at the 90th Annual American Society for Clinical Pharmacology and Therapeutics Meeting, Nashville, TN, March 1989.
Identification
Copyright
© 1992 Published by Elsevier Inc.
