Effectiveness of Sodium Bicarbonate Administration in Out-of-Hospital Cardiac Arrests: An Updated Systematic Review and Meta-Analysis.
Prehospital emergency care · 2025-10-15 · Meta-analysis
Abstract
OBJECTIVES: The use of sodium bicarbonate (SB) in the treatment of cardiac arrest without known etiology is still controversial and is not routinely recommended by the American Heart Association guidelines. This study summarizes current evidence on the use of SB in out-of-hospital cardiac arrest (OHCA). METHODS: We systematically searched PubMed, Scopus, and Cochrane databases for randomized controlled trials (RCTs) and observational studies evaluating SB in OHCA. Return of spontaneous circulation (ROSC) was the primary outcome, explicitly defined as the return of a palpable pulse and measurable blood pressure; sustained ROSC (≥20 min) was noted separately. Survival to discharge was a secondary outcome. Using a random-effects model, we pooled Odds Ratios (OR) for binary outcomes with 95% confidence intervals (CI). RESULTS: Eleven studies (2 RCTs, 9 observational; N = 126,013) were included. No significant differences were observed in ROSC (OR 0.85, 95% CI 0.59-1.23; p = 0.38) or survival to discharge (OR 0.63, 95% CI 0.17-2.28; p = 0.48). CONCLUSIONS: Administration of sodium bicarbonate in patients with OHCA was not associated with improved ROSC or survival to discharge. Therefore, its routine use cannot be recommended. However, our review does not exclude the possibility of benefit in selected, guideline-specified contexts such as hyperkalemia or tricyclic antidepressant overdose, or when administered early during resuscitation. Further high-quality studies with standardized reporting of etiology, timing, dose, and airway management are needed to clarify these potential indications.