Sodium bicarbonate to the ROSCue: a case report on how sodium bicarbonate successfully resuscitated a patient in cardiac arrest from suspected quetiapine and trazodone overdose.
European Heart Journal. Case Reports · 2025-10-27 · Case report
Abstract
BACKGROUND: Per ACLS algorithms (Class III, LOE B), sodium bicarbonate (SB) use is indicated for cardiac arrest with underlying hyperkalaemia, tricyclic antidepressant (TCA) overdose, or pre-existing severe metabolic acidosis, with routine use of SB being discouraged due to concerns raised in animal studies. However, SB is a potent antidote for sodium channel blockade (SCB) in drug toxicities beyond TCA toxicity and should be considered more broadly. CASE SUMMARY: We present a 50-year-old man who suffered an out-of-hospital cardiac arrest with a wide-complex bradycardia (QRS 184 ms) due to suspected quetiapine (atypical antipsychotic) and trazodone (serotonin modulator) overdose. After SB administration, the QRS narrowed to 142 ms and ROSC was immediately achieved. DISCUSSION: Trazodone, a popular sleep medication, rarely leads to cardiac arrhythmias, and secondary cardiac arrest is exceptionally rare. Nonetheless, both trazodone and quetiapine can cause SCB in toxic doses. Intravenous SB can rapidly overcome medication-induced SCB and narrow a prolonged QRS and/or QTc interval. Although the role of SB in cardiac arrest remains limited, SB in SCB toxicity in TCA overdose and in other drug toxicities can be life-saving. SB should be considered in patients with wide QRS and suspected drug overdose.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Antidepressants · Antidotes · Antipsychotics · Mortality & survival · Other drugs · Poisoning & substance use · Sedatives & anxiolytics · Sodium bicarbonate
Related articles
- Successful use of therapeutic hypothermia after cardiac arrest due to amitriptyline and venlafaxine intoxication. (Ther Hypothermia Temp Manag, 2015)
- Intraosseous administration of antidotes - a systematic review. (Clin Toxicol (Phila), 2017)
- Tricyclic antidepressant poisoning: an evidence-based consensus guideline for out-of-hospital management. (Clin Toxicol (Phila), 2007)
- Clinical predictors of shockable versus non-shockable rhythms in patients with out-of-hospital cardiac arrest. (Resuscitation, 2016)
- Intravenous lipid emulsion as antidote beyond local anesthetic toxicity: a systematic review. (Acad Emerg Med, 2009)
- 2023 American Heart Association Focused Update on the Management of Patients With Cardiac Arrest or Life-Threatening Toxicity Due to Poisoning: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. (Circulation, 2023)