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Physiologic response to sodium bicarbonate administration during pediatric in-hospital cardiac arrest
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DOI：10.3389/fmed.2026.1857577.png)
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Abstract
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AimTo explore the physiologic response to sodium bicarbonate (SB) administration during pediatric in-hospital cardiac arrest (p-IHCA) and its association with outcomes.MethodsRetrospective single-center study of patients < 18 years old who experienced IHCA with an arterial line in place and received intra-arrest SB from 2013 to 2023. To evaluate the hemodynamic response to SB in isolation; events in which vasopressors were administered the minute before; during or after the first dose of SB were excluded. The primary outcome was the change in diastolic blood pressure (DBP). Patients were classified as SB responders if DBP increased ≥5 mmHg. To assess for a potential enhancement on vasopressor efficacy; a secondary analysis was performed examining the difference-in-difference between the DBP response to epinephrine before and after SB administration.ResultsThirteen patients were included in the primary analysis; with a median DBP change of 4 mmHg (95% CI: −3; 11 after SB administration (p = 0.31). Of these; 6 (46%) patients were classified as SB responders. There were no significant differences in outcomes between SB responders and non-responders. Ten patients were included in the secondary analysis. There was no significant change in the difference-in-difference between the DBP response to epinephrine before and after SB administration [−2 mmHg (95% CI: −9; 7); p = 0.56].ConclusionsIn this small cohort study; SB administration during p-IHCA was not associated with a significant change in DBP or an augmented DBP response to epinephrine. SB responder status was not associated with outcomes; though power to detect differences was low due to sample size.
Keywords:
pediatric
cardiac arrest
blood pressure
cardiopulmonary resuscitation
sodium bicarbonate
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