Prehospital sodium bicarbonate therapy in patients experiencing nontraumatic out-of-hospital cardiac arrest (OHCA) has not been well studied in large randomized controlled trials with regard to its possible advantages on neurologic outcomes. For a study, researchers sought to collect data that would be useful in creating a randomized controlled trial of bicarbonate treatment following OHCA in particular patient subgroups.
Two unique, unrelated datasets were the subject of two independent, concurrent, retrospective analyses. One dataset was a population-based registry that covered all of France (RéAC Registry, French dataset), while the other was a North American randomized controlled trial that compared continuously versus interrupted chest compressions (ROC-CCC trial, North-American dataset). They looked into whether prehospital administration of bicarbonate was linked to improved neurologic results.
The functional result upon hospital release served as the primary outcome indicator. They performed a nested propensity-score matched analysis with inverse probability-of-treatment weighting to account for possible confounders. A total of 1,234 (2.2%) of the 54,807 patients in the French sample got sodium bicarbonate, and 450 were matched. Sodium bicarbonate was not linked to a greater chance of favorable functional outcomes on day 30 after propensity-score matching [adjusted odds ratio (aOR), 0.912; 95%CI, 0.501-1.655]. Of the 23,711 patients that were included in the North American dataset, 4,902 (20.6%) got sodium bicarbonate, and 1,238 were matched. Sodium bicarbonate was linked to a reduced chance of favorable functional outcomes at hospital release after propensity-score matching (aOR, 0.45; 95% CI, 0.34-0.58).
Prehospital sodium bicarbonate therapy in patients with OHCA was linked to worse neurologic outcomes in a North American dataset but not to neurologic outcomes in a French dataset. In order to ascertain whether sodium bicarbonate plays a part in the prehospital management of prolonged OHCA, a sizable randomized clinical trial targeting particular patient subgroups may be required. This was due to the considerable variation in sodium bicarbonate use by various prehospital care systems and the potential resuscitation-time bias in the current study.
