Indications for sodium bicarbonate in cardiopulmonary resuscitation

Reasons for not advocating active use of sodium bicarbonate in cardiopulmonary resuscitation:

1． Transient alkalosis, which shifts the oxygen dissociation curve to the left, reduces the release of oxygen in hemoglobin, aggravates the hypoxia of tissues;

2． Electrolyte balance disorders reduce the ratio of free calcium to non-free calcium, so that potassium ions in the serum enter the cells, induce malignant arrhythmias, and produce hypernatremia, increasing plasma osmolality.

3． Sodium bicarbonate itself can directly inhibit heart function and reduce the activity of catecholamines;

4． Sodium bicarbonate decomposes in the body to produce carbon dioxide, in general, the carbon dioxide generated by the drug needs to be discharged with greater hyperventilation, and carbon dioxide is easier to pass through the blood-brain barrier than bicarbonate and hydrogen ions, if the carbon dioxide is exhaled without over-ventilation, when the pH value is increased by giving sodium bicarbonate, because the sodium bicarbonate decomposition product carbon dioxide is diffused into the brain through the blood-brain barrier, the pH of the brain is not increased, but on the contrary, it is significantly reduced, which eventually leads to cerebral edema;

Due to the above drawbacks in the early application of sodium bicarbonate, the use of sodium bicarbonate is only considered in the following cases:

1． The pH remains below 7.2 after 10 minutes of effective ventilation and closed chest compressions.

2． Metabolic acidosis before cardiac arrest;

3． With severe hyperkalemia.

For the first time, the specific dose of sodium bicarbonate can be analyzed according to the standard of 1 mmol/kg body weight, and then analyzed with reference to the results of blood gas analysis.