ABSTRACTS
Prehospital Sodium Bicarbonate AdministrationAuthor: Angel Sheu | EMT-P (Paramedic), Medical Student | Anne Burnett Marion School of Medicine at Texas Christian University Associate Authors: Bourmand, Raika, M.Sc.
Introduction Sodium bicarbonate is frequently administered during cardiac arrest to address metabolic acidosis and specific toxicologic emergencies. However, its routine use in prehospital cardiac arrest remains controversial. Current guidelines discourage empiric administration except for defined indications, yet practice patterns and protocols vary considerably. This scoping review evaluated the existing evidence regarding prehospital sodium bicarbonate administration and its association with patient survival and neurologic outcomes. Methods We conducted a systematic literature search of PubMed, Embase, and Cochrane CENTRAL covering January 2000 through April 2025. Search terms included “sodium bicarbonate,” “prehospital,” “EMS,” and “cardiac arrest.” Eligible studies reported original data on prehospital sodium bicarbonate administration during adult cardiac arrest and included patient-centered outcomes. Exclusion criteria comprised in-hospital-only studies, animal experiments, pediatric populations, and single-patient case reports. Search results were imported into Covidence software for screening. Two reviewers independently assessed studies, extracted data on study design, patient characteristics, indications for bicarbonate use, return of spontaneous circulation (ROSC), survival to hospital discharge, and neurologic status. Study quality for final inclusion was evaluated using Joanna Briggs Institute (JBI) recommended approaches. Results The search identified multiple observational studies and registry analyses assessing prehospital sodium bicarbonate use. Most studies reported no significant association between empiric administration and improved rates of ROSC or survival to discharge. One large registry analysis suggested potential benefit in prolonged resuscitation efforts exceeding 20 minutes; however, these findings were limited by confounding and selection bias. No studies demonstrated improved neurologic outcomes associated with routine bicarbonate administration. Reported adverse effects included metabolic alkalosis, hypernatremia, and paradoxical intracellular acidosis. Overall, the evidence base consisted primarily of retrospective cohort studies of moderate methodological quality, with few prospective investigations. Conclusion Available evidence does not support routine prehospital administration of sodium bicarbonate during cardiac arrest except in specific clinical scenarios such as hyperkalemia or tricyclic antidepressant overdose. Studies consistently demonstrate no improvement in survival or neurologic outcomes with empiric use and highlight potential risks. These findings reinforce guideline recommendations emphasizing targeted administration. Further research is needed to clarify the role of bicarbonate in prolonged resuscitation and better define patient subgroups who may benefit.
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