title: Sodium bicarbonate use during in-hospital pediatric pulseless cardiac arrest - a report from the American Heart Association Get With The Guidelines(®)-Resuscitation.
abstract: BACKGROUND
  Despite limited recommendations for using sodium bicarbonate (SB) during cardiopulmonary resuscitation (CPR), we hypothesized that SB continues to be used frequently during pediatric in-hospital cardiac arrest (IHCA) and that its use varies by hospital-specific, patient-specific, and event-specific characteristics.
  
  
  METHODS
  We analyzed 3719 pediatric (<18 years) index pulseless CPR events from the American Heart Association Get With The Guidelines-Resuscitation database from 1/2000 to 9/2010.
  
  
  RESULTS
  SB was used in 2536 (68%) of 3719 CPR events. Incidence of SB use between 2000 and 2005 vs. 2006 and 2010 was 71.1% vs. 66.2% (P=0.002). The primary outcome was survival to discharge. Secondary outcomes included 24-h survival and neurologic outcome. Multivariable logistic regression analyzed the association between SB use and outcomes. SB had increased use an ICU location, metabolic/electrolyte disturbance, prolonged CPR, pVT/VF, and concurrently with other pharmacologic interventions. Adjusting for confounding factors, SB use was associated with decreased 24-h survival (aOR 0.83, 95% CI: 0.69, 0.99) and decreased survival to discharge (aOR 0.80; 95% CI: 0.65, 0.97). Inclusion of metabolic/electrolyte abnormalities, hyperkalemia, and toxicologic abnormalities only (n=674), SB use was not associated with worse outcomes or unfavorable neurologic outcome.
  
  
  CONCLUSIONS
  SB is used frequently during pediatric pulseless IHCA, yet there is a significant trend toward less routine use over the last decade. Because SB is more likely to be used in an ICU, with prolonged CPR, and concurrently with other pharmacologic interventions; its use during CPR may be associated with poor prognosis due to an association with "last ditch" efforts of resuscitation rather than causation.
authors.affiliation: Department of Pediatrics and Critical Care Medicine, Section of Pediatric Cardiac Intensive Care, Medical City Children's Hospital, Dallas, TX, United States.
authors.forename: Tia T
authors.initials: TT
authors.lastname: Raymond
authors.affiliation: Department of Pediatrics and Critical Care Medicine, Section of Pediatric Cardiac Intensive Care, Medical City Children's Hospital, Dallas, TX, United States.
authors.forename: Daniel
authors.initials: D
authors.lastname: Stromberg
authors.affiliation: Department of Pediatrics and Critical Care Medicine, Section of Pediatric Cardiac Intensive Care, Medical City Children's Hospital, Dallas, TX, United States.
authors.forename: William
authors.initials: W
authors.lastname: Stigall
authors.affiliation: Department of Pediatrics and Critical Care Medicine, Section of Pediatric Cardiac Intensive Care, Medical City Children's Hospital, Dallas, TX, United States.
authors.forename: Grant
authors.initials: G
authors.lastname: Burton
authors.affiliation: Department of Pediatrics, Children's Hospital of The King's Daughters, Norfolk, VA, United States. Electronic address: tiaraymond@me.com.
authors.forename: Arno
authors.initials: A
authors.lastname: Zaritsky
mesh_terms: D000293:Adolescent; D000572:American Heart Association; D016887:Cardiopulmonary Resuscitation; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D011674:Pulse; D012042:Registries; D017693:Sodium Bicarbonate / Q000627:therapeutic use*; D015996:Survival Rate; D014481:United States
chemical_list: D017693:Sodium Bicarbonate
keywords: Cardiac arrest; Cardiopulmonary resuscitation; Pediatrics; Sodium bicarbonate; Survival