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Sodium Bicarbonate Use in Shock and Cardiac Arrest: Attitudes of Pediatric Acute Care Physicians*

Parker, Melissa J. MD, MSc, FRCPC, FAAP (PCCM, PEM)1,2; Parshuram, Christopher S. Mb ChB, DPhil3–6

doi: 10.1097/CCM.0b013e31828a6669
Pediatric Critical Care

Objectives: To evaluate the preferences and self-reported practices of pediatric acute care physicians with respect to sodium bicarbonate administration to infants and children in shock or cardiac arrest.

Design: National survey study utilizing a self-administered questionnaire.

Setting: Thirteen Canadian pediatric tertiary care centers.

Subjects: Canadian pediatric critical care physicians, pediatric emergency physicians, and trainees in these subspecialties.

Interventions: None.

Measurements and Main Results: Survey items were evaluated based on Yes/No responses, frequency responses, and Likert scales. Overall response rate was 53% (151/284) with 49.0% (74/151) citing pediatric critical care as their primary practice. 82.0% of respondents (123/150) indicated they would administer sodium bicarbonate as part of ongoing resuscitation for septic shock, whereas 58.3% (88/151) would administer sodium bicarbonate in a cardiac arrest scenario (p = 0.004). 47.3% (71/150) selected a pH threshold at or below which they would administer sodium bicarbonate (mean, 6.94 ± 0.013; median, 7.00; range, 6.50–7.20; interquartile range, 6.90–7.00), whereas 20.5% (31/151) selected a base excess threshold (mean, –15.62 ± 0.78; median, –16; range, –20 to –4; interquartile range, –20 to –14). Both pH and duration of resuscitation were strongly associated with the decision to administer sodium bicarbonate (p < 0.0001). Respondents’ perceptions regarding a colleague’s likelihood of administering sodium bicarbonate to the same patient under the same circumstances reflect an acknowledgment of disparate practices with respect to sodium bicarbonate use. 53.0% (79/149) felt current American Heart Association guidelines help them in deciding whether to administer sodium bicarbonate to critically ill patients, and 84% would support a randomized trial.

Conclusion: Differences of opinion exist among pediatric acute care physicians with respect to the timing and appropriateness of sodium bicarbonate administration during resuscitation. Most indicated they would support moving forward with a clinical trial. (Crit Care Med 2013; 41:2188–2195)

1Division of Critical Care, Department of Pediatrics, McMaster Children’s Hospital and McMaster University, Hamilton, Canada.

2Division of Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Canada.

3Paediatric Intensive Care Unit, Hospital for Sick Children, Toronto, Canada.

4Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Canada.

5Center for Safety Research, Child Health Evaluative Sciences, The Research Institute, Hospital for Sick Children, Toronto, Canada.

6Paediatrics, Critical Care, Health Policy, Management & Evaluation, Center for Patient Safety, University of Toronto, Toronto, Canada.

* See also p. 2242.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Drs. Parker and Parshuram were supported by the Centre for Safety Research, The Hospital for Sick Children; and Dr. Parker by MAC New Faculty Research Start-up, McMaster University.

The authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: parkermj@mcmaster.ca

© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins