Sodium bicarbonate administration during in-hospital pediatric cardiac arrest: A systematic review and meta-analysis. (May 2021)

• Record Type: Journal Article
• Authors: Chang, Chih-Yao; Wu, Po-Han; Hsiao, Cheng-Ting; Chang, Chia-Peng; Chen, Yi-Chuan; Wu, Kai-Hsiang
• Is Part Of: Resuscitation. Volume 162(2021)
• Page Start: 188
• Page End: 197
• Publication Date: 2021-05
• Subjects: CI confidence interval -- IHCA in-hospital cardiac arrest -- LOE level of evidence -- NOS Newcastle-Ottawa scale -- OHCA out-of-hospital cardiac arrest -- OR odds ratio -- PALS pediatric advanced life support -- PCPC pediatric cerebral performance category -- PLS Pediatric Life Support -- PRISMA preferred reporting items for systematic reviews and meta-analysis -- ROSC return of spontaneous circulation -- SB sodium bicarbonate -- GRADE The Grading of Recommendations Assessment, Development and Evaluation; Sodium bicarbonate -- In-hospital cardiac arrest -- Pediatric -- Cardiac resuscitation -- Systematic review -- Meta-analysis; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2021.02.035
• Languages: English
• ISSNs: 0300-9572

Abstract

Abstract: Background: Current American Heart Association Pediatric Life Support (PLS) guidelines do not recommend the routine use of sodium bicarbonate (SB) during cardiac arrest in pediatric patients. However, SB administration during pediatric resuscitation is still common in clinical practice. The objective of this study was to assess the impact of SB on mortality and neurological outcomes in pediatric patients with in-hospital cardiac arrest. Methods: We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials from inception to January 2021. We included studies of pediatric patients that had two treatment arms (treated with SB or not treated with SB) during in-hospital cardiac arrest (IHCA). Risk of bias was assessed using the Newcastle-Ottawa Scale and the certainty of evidence was assessed using GRADE system. Results: We included 7 observational studies with a total of 4877 pediatric in-hospital cardiac arrest patients. Meta-analysis showed that SB administration during pediatric cardiac resuscitation was associated with a significantly decreased rate of survival to hospital discharge (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.25–0.63, p value = 0.0003). There were insufficient studies for 24-h survival and neurologic outcomes analysis. The subgroup analysis showed a significantly decreased rate of survival to hospital discharge in both the "before 2010" subgroup (OR 0.47; 95% CI 0.30–0.73; p value = 0.006) and the "after 2010" subgroup (OR 0.46; 95% CI 0.25–0.87; p value = 0.02). The certainty of evidence ranged from very low to low. Conclusions: This meta-analysis of non-randomized studies supported current PLS guideline that routine administration of SB is not recommended in pediatric cardiac arrest except in special resuscitation situations. Trial registration: The protocol was registered with PROSPERO on 8 August 2020 (registration number: CRD42020197837).