Bicarb Is Dead ... Or For The Dead?

Let the debates continue!

It has been decades since sodium bicarbonate carried a favorable recommendation in the American Heart Association guidelines – yet, consistent with zombie therapies the world over, it continues to be used.

Attempting to settle the debate with some finality, we have the BIHCA randomized trial for in-hospital cardiac arrest.

As seems to be the general theme for resuscitation trials, we find a “neutral” result:

A small absolute and relative difference in ROSC, a small absolute and (larger) relative difference in useful survival outcomes. There was little insight in the subgroup analysis as to which patients were feeding into these small differences:

Which, unfortunately, leaves us back where we started. The exclusion of sodium bicarbonate from resuscitation efforts is entirely valid. However, for those who have retained its use, there’s no obvious signal of harm, nor is bicarbonate expensive other than the time-cost and cognitive burden of its use during the acute event. The posterior Bayesian likelihoods of effectiveness are not strong enough to really move the needle on someone’s practice, one way or the other. And, so, another grand effort – which probably won’t change anything.