Cardiovascular Critical Care II
| (4) | Producing excess CO2 through rapid dissociation, which can freely diffuse |
|---|
intracellularly (e.g., myocardial and cerebral cells) and cause intracellular acidosis
| (5) | Inactivation of concurrently administered catecholamines (e.g., epinephrine) (Hosp |
|---|
Pharm 1969;4:14-22).
| (f) | Certain circumstances may warrant sodium bicarbonate use such as tricyclic antidepressant |
|---|
overdose, bicarbonate (HCO3-)-wasting causes of metabolic acidosis, and hyperkalemia.
In addition, it should be noted that endogenous catecholamines have a blunted response
during acidosis which may improve if the acidosis is corrected. Initial dosage should usually
be 1 mEq/kg intravenous push with monitoring of clinical status, HCO3- concentration,
laboratory values, and blood gas analysis.
| (g) | Recent meta analysis of RCTβs found that use of sodium bicarbonate was not superior |
|---|
compared with control in regards to survival and ROSC and may be associated with lower
rates of sustained ROSC and good neurological outcome (Int J Emerg Med 2021;14:21).
| (h) | A recent RCT in a porcine model of hyperkalemia-induced cardiac arrest discovered that |
|---|
sodium bicarbonate was associated with increased rates of ROSC and reduced time to
ii.
Calcium
| (a) | No trial has established any impact on survival in either IHCA or OHCA (Ann Emerg Med |
|---|
| (b) | Consider in patients with preexisting hypocalcemia and signs and symptoms of acute |
|---|
hypocalcemia (e.g., severe tetany or seizures).
| (c) | A recent RCT in a porcine model of hyperkalemia-induced cardiac arrest discovered that |
|---|
calcium chloride was not associated with increased rates of ROSC or time to ROSC (Crit
iii.
Atropine
| (a) | No prospective studies have evaluated atropine for bradycardic PEA or asystolic cardiac |
|---|
arrest.
| (b) | Conflicting results exist from retrospective analyses and case reports (Acta Anaesthesiol |
|---|
| (c) | Atropine has not been associated with harm in treating bradycardic PEA or asystolic cardiac |
|---|
arrest, but because of the lack of convincing evidence of benefit, it is no longer recommended
for cardiac arrest but is reserved for symptomatic/life-threatening bradycardia.
iv.
Intravenous fluids
| (a) | Normothermic, hypertonic, and chilled fluids have been evaluated in animal models and |
|---|
small human studies, with no survival benefit.
| (b) | If hypovolemic shock is the suspected cause of the cardiac arrest, fluid resuscitation should |
|---|
be initiated immediately.
For indications of fibrinolysis for cardiac arrest, see the Pulmonary chapter for treatment of
pulmonary embolism and the Cardiology chapter for treatment of acute myocardial infarction.
vi.
Pacing
| (a) | Transcutaneous, transvenous, and transmyocardial pacing is not beneficial in cardiac arrest |
|---|
and does not improve ROSC or survival.
| (b) | Not recommended for routine use in cardiac arrest. |
|---|
vii.
Dextrose
| (a) | Animal data has demonstrated that dextrose administration before, during, or after cardiac |
|---|
1987;2:4β14; Surgery 1990;72:1005β11; Acta Anaesthesiol 1986;100:505β11).