Buffer therapy during out-of-hospital cardiopulmonary resuscitation.
The effects of infusing a buffer solution on resuscitability and outcome was tested in patients during out-of-hospital cardiac arrest. A number (502) of adults with asystole or ventricular fibrillation with failure of first defibrillation attempt were entered into a prospective, randomized, double-blind, controlled trial. Of these, 245 patients received 250 ml of sodium bicarbonate-trometamol- phosphate mixture with buffering capacity 500 mmol/l and 257 patients received 250 ml 0.9% saline. Except for the investigational infusion, all patients were resuscitated according to international guidelines. Eighty-seven patients (36%) receiving buffer were admitted to hospital ICU and 24 (10%) were discharged from hospital alive, vs. 92 (36%) and 35 (14%) receiving saline (95% confidence interval (CI) for difference between groups: -6%-6% for rate of admission and -1%-9% for rate of discharge). Using a logistic regression analysis, ventricular fibrillation as initial rhythm (odds ratio 8.06, CI 3.70-17.56) improved the outcome, whereas buffer therapy had no effect (odds ratio 0.77, CI 0.43-1.41). Mean base excess at hospital admission was -9 after Tribonat vs. -11 after saline (P = 0.04, CI for difference 0.2-3.8). Only 16 of the 502 patients had arterial alkalosis on arrival in the hospital and no patient had a positive base excess. Patients resuscitated after out-of-hospital cardiac arrest had metabolic acidosis, but buffer therapy did not improve the outcome.
Dybvik
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T
Department of Anaesthesiology, Ullevaal University Hospital, Oslo, Norway.
Strand
T
T
Steen
P A
PA
D000138:Acidosis / Q000188:drug therapy / Q000209:etiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001639:Bicarbonates / Q000008:administration & dosage / Q000627:therapeutic use*; D016887:Cardiopulmonary Resuscitation; D002648:Child; D004311:Double-Blind Method; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012965:Sodium Chloride / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome; D014325:Tromethamine / Q000008:administration & dosage / Q000627:therapeutic use*
D001639:Bicarbonates; D014325:Tromethamine; C091201:Tribonate; D012965:Sodium Chloride