Sodium bicarbonate in cardiac resuscitation

Indications for sodium bicarbonate are severe metabolic acidosis during prolonged cardiac or respiratory arrest - the diagnosis must be supported by blood gases.

In most cases the acidosis of cardiac arrest should be corrected by CPR; however, in longer arrests lactic acid production may occur as a result of anaerobic respiration will cause a metabolic acidosis which may need correction. Note that the acidosis will be mostly venous; arterial gases may give misleading results.

It acts to:

• increase the threshold for going into VF
• improves the action of catecholamines
• improves myocardial contractility

Its actions have not been confirmed in any satisfactory trial.