Early Sodium Bicarbonate Use in Pediatric In-Hospital Cardiac Arrest: A Single-Center, Retrospective Cohort Study, 2013-2023

OBJECTIVES:To explore the association of intra-arrest sodium bicarbonate (SB) use with outcomes in pediatric in-hospital cardiac arrest (p-IHCA) when accounting for the timing of initial SB administration. We hypothesized that administration of SB within the first 5 minutes of p-IHCA would be associated with greater odds of hospital survival and return of spontaneous circulation (ROSC).DESIGN:Retrospective cohort study.SETTING:Quaternary care academic children's hospital.PATIENTS:Children 18 years old or younger with pulseless IHCA of at least 5 minutes duration at our institution between January 2013 and January 2023 with complete data were included.INTERVENTIONS:None.MEASUREMENTS AND MAIN RESULTS:Of 243 index events of p-IHCA, 99 (41%) received SB in the first 5 minutes of cardiopulmonary resuscitation (CPR). Overall, 107 patients (44%) survived to hospital discharge and ROSC was achieved in 91 of 243 patients (37%). A logistic treatment-effects estimation utilizing inverse-probability weighting via a propensity score was performed to compare the effects of SB use within the first 5 minutes of CPR with those who did not receive early SB. In this analysis, we failed to detect an association between early SB, compared with not, and differing adjusted odds of survival to discharge (adjusted odds ratio [aOR], 0.87; 95% CI, 0.45-1.69; p = 0.687) and ROSC (aOR, 0.82; 95% CI, 0.43-1.56; p = 0.537).CONCLUSIONS:In this retrospective cohort study of p-IHCA, we failed to detect an association between timing of SB and odds of survival to hospital discharge and ROSC. These findings warrant reevaluation of the evidence and support a less restrictive recommendation for SB use during p-IHCA in U.S. national guidelines.