Direct quote from the International Guidelines 2000:
"Little data indicates that therapy with buffers improves outcome. On the
contrary, there is laboratory and clinical data indicating that bicarbonate:
1) Does not improve the ability to defibrillate or improve survival rates in
animals
2) Can compromise coronary perfusion pressure
3) May cause adverse effects due to extracellular acidosis, including shifting
the oxyhaemoglobin saturation curve or inhibiting the release of oxygen
4) May induce hyperosmolarity and hypernatraemia
5) Produces carbon dioxide, which is freely diffusible into myocardial and
cerebral cells and may paradoxically contribute to intracellular acidosis
6) Exacerbates central venous acidosis
7) May inactivate simultaneously administered catecholamines."
The acidosis in cardiac arrest is a result of low blood flow - the best
therapy is adequate CPR and ventilation. Remember that the Americans have not
updated their guidelines since 1992, unlike us lot who updated in 1997/8 when
bicarbonate was de-emphasised. With the International Guidelines 2000, the
Americans should now come on line with this approach on the basis of current
evidence.
Hope this answers your question!
Andy
>===== Original Message From The list will be of relevance to all trainees
including undergraduates and <[log in to unmask]> =====
>Hi
>Recently I popped over to 'run' with Seattle Medic One. Which is arguably the
>best paramedic service in the world? They guarantee a 49% success rate on
>cardiac related arrest. I witness this first hand - 4 cardiac arrests and
>they got 2 back.
>
>The reason for the posting was that on one of the arrests they used Calcium.
>24 year old male weighing about 22 stone who was a renal dialysis patient. He
>was in asystole with fire-fighters doing CPR. We (medics) got to the incident
>after about a 9 minute journey and they tubed him, IV access and gave Epi and
>asystole. They then followed it with Sod Bicarb and Calcium. They got a
>rhythm and pulse back after a couple more minutes and remained in NSR all the
>was to ER.
>
>These chaps have a bunch of drugs at their disposal and will administer it on
>the basis of patient needs (i.e. what the drug can do to reverse the arrest).
>
>Sod Bicarb is regarded as a first line treatment after Epi and Calcium is
>there if they need it. So, anecdotally - I've seen it work and therefore - it
>works. Can anyone prove it has NO place in the cardiac arrest protocol to
>warrent not having it in their drugs kit?
>
>Mike Bjarkoy
Totalise - the Users ISP
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