Bicarbonate in paediatric ALS

Sodium bicarbonate is often used in the resuscitation of children, with the aim of reducing the acidosis presumed to occur during an arrest.

• cardiac arrest results in combined respiratory and metabolic acidosis, caused by cessation of pulmonary gas exchange, and the development of anaerobic cellular metabolism respectively
  • best treatment for acidaemia in cardiac arrest is a combination of chest compression and ventilation. Furthermore, giving bicarbonate causes generation of carbon dioxide which diffuses rapidly into the cells. This has the following effects:
    • exacerbates intracellular acidosis
    • produces a negative inotropic effect on ischaemic myocardium
    • presents a large, osmotically active, sodium load to an already compromised circulation and brain
    • produces a shift to the left in the oxygen dissociation curve further inhibiting release of oxygen to the tissues
  • routine use of sodium bicarbonate in cardiac arrest is not recommended.
    • may be considered in prolonged arrest, and it has a specific role in hyperkalaemia and the arrhythmias associated with tricyclic antidepressant overdose. The dose is 1-2 ml per kg of the 8.4% solution given by the IV or IO routes

Reference:

1. Resuscitation Council (UK). Advanced Paediatric Life Support. Guidelines 2005.