Sodium Bicarb Administration

Question#: 632

Question:

Is there any talk of placing Sodium Bicarb in the Cardiac Arrest directive with safety parameters in place of course so that the Patients who could possibly benefit from this can just get this rather than needing to patch in taking time away from urgent other things?

Answer:

Sodium Bicarb use to have a medical directive but it was removed years ago however, it remains in the Provincial Equipment Standards for Ontario Ambulance Services by the MOHLTC and therefore, it is a mandatory medication that must stocked in the ambulances.
Since it does not have it's own medical directive, a patch is required which a BHP may or may not grant.
There was a time when Sodium Bicarb was routinely given in cardiac arrest patients however, current medicine suggests there are potential downsides which include electrolyte derangements (reduction in ionized calcium), volume overload, hypercapnia leading to compensatory respiratory acidosis, and hyperosmolarity leading to increased vascular resistance.
According to recent studies there is no statistical significant difference for sustained ROSC, survival to hospital admission, or good neurologic outcome.
The most recent European Resuscitation Council and American Heart Association do not recommend its routine use in cardiac arrest, except for TCA overdoses. It used to also be used for hyperkalemia-associated cardiac arrest however, we now carry Calcium Gluconate for these patients. Although it has not been well studied for these specific indications, it is physiologically sensible.
We are always exploring advancements and will be looking into this further in order to determine the risk/benefit of administering this medication to patients, how often it is administered, and if it requires a directive or needs to be removed.
References:
https://emottawablog.com/2019/02/sodium-bicarbonate-supply-shortages-and-medical-shortcomings/
http://www.emdocs.net/sodium-bicarbonate-therapy-does-not-work-in-cardiac-arrest/
https://rebelem.com/sodium-bicarbonate-in-cardiac-arrest-management/