Effectiveness of Sodium Bicarbonate Administration on Mortality in Cardiac Arrest Patients: A Systematic Review and Meta-analysis

J Emerg Med. 2020 Dec;59(6):856-864. doi: 10.1016/j.jemermed.2020.08.012. Epub 2020 Sep 22.


Background: The 2010 Advanced Cardiac Life Support guidelines stated that routine sodium bicarbonate (SB) use for cardiac arrest patients was not recommended. However, SB administration during resuscitation is still common.

Objectives: To evaluate the effect of SB on return of spontaneous circulation (ROSC) and survival-to-discharge rates in adult cardiac arrest patients.

Methods: We searched Medline, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) from inception to December 2019. We included trials on nontraumatic adult patients after cardiac resuscitation and SB treatment vs. controls.

Results: A meta-analysis was performed with six observational studies, including 18,406 adult cardiac arrest patients. There were no significant differences in the ROSC rate (odds ratio [OR] 1.185; 95% confidence interval [CI] 0.680-2.065) and survival-to-discharge rate (OR 0.296; 95% CI 0.066-1.323) between the SB and no-SB groups. In the subgroup analysis based on the year factor, there were no significant differences in the mortality rate in the After-2010 group. In the subgroup analysis based on the continent, the ROSC rate (OR 0.521; 95% CI 0.432-0.628) and survival-to-discharge rate (OR 0.102; 95% CI 0.066-0.156) were significantly lower in the North American group.

Conclusions: SB use was not associated with improvement in ROSC or survival-to-discharge rates in cardiac resuscitation. In addition, mortality was significantly increased in the North American group with SB administration.

Keywords: cardiac arrest; meta-analysis; sodium bicarbonate.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adult
  • Advanced Cardiac Life Support
  • Cardiopulmonary Resuscitation*
  • Heart Arrest* / drug therapy
  • Humans
  • Out-of-Hospital Cardiac Arrest* / drug therapy
  • Patient Discharge
  • Sodium Bicarbonate / therapeutic use


  • Sodium Bicarbonate