Sodium Bicarbonate Administration During Pediatric CPR

Introduction:

Cardiac arrest is a commonly found cause of death throughout the world. Cardiac arrest happens when the heart stops working all of a sudden with an absence of blood circulation, breathing, and consciousness. The cause of cardiac arrest is mostly of cardiac origin, with some cases due to non-cardiac reasons such as drug overdose, primary respiratory arrest, asphyxia, drowning, and electrocution.

How Does Cardiopulmonary Resuscitation Manage Cardiac Arrest?

Cardiopulmonary resuscitation (CPR) is an emergency procedure performed to save a patient’s life who is in sudden cardiac arrest. It can improve the chances of survival after an arrest. It works by giving chest compressions on the center of the chest at regular intervals. It keeps the movement of air and blood active and minimizes brain damage. CPR can give temporary breathing and circulatory support till the medical team arrives at the site with help and other advanced basic life support devices. Advanced life support (ALS) has developed guidelines to perform and apply to patients during an emergency.

What Is Sodium Carbonate?

Sodium bicarbonate is also called baking soda. This chemical compound disintegrates as sodium and bicarbonate when mixed in water. This makes the solution alkaline meaning it can neutralize the acids. Because of this property of sodium bicarbonate, it can be utilized in medical conditions of high acidity in body fluids. They are classified under antacid drugs. Sodium bicarbonate is used in ingestion, heartburn, and stomach ulcers. They are usually prescribed to people with a history of stomach ulcers. It is available in tablet, granule, and solution forms.

How Is Cardiopulmonary Resuscitation Performed in Pediatric Patients?

CPR is performed by someone who has completed training in a CPR course. The techniques are developed to give importance to compressions compared to breathing.

All parents and caregivers of children must learn CPR. Children who suffer cardiac arrest are unconscious and unresponsive. Implementing quick CPR and prompt decision-making is essential to manage a child and reduce the chances of permanent nervous system damage since the brain damage starts after 4 minutes in the absence of an oxygen supply. Death can occur soon after 4 to 6 minutes of cut-off from the oxygen supply.

Nowadays, a portable electronic machine called an automated external defibrillator (AED) is used in many places, which consists of pads that are stuck on the child’s chest and can read the heart’s rhythm during an emergency. The device also gives a shock to stimulate heart functions. It requires minimum training to use an AED since it is comparatively easier to use. The following conditions can stop a child’s heart from functioning and breathing:

• Drowning.

• Electric shock.

• Choking.

• Excess blood loss from bleeding.

• Pulmonary disease.

• Poisoning.

• Suffocation.

• Head and other fatal injuries.

The child experiences the following symptoms during a cardiac arrest and will indicate the need to perform CPR.

• Unconsciousness.

• Unresponsive.

• Absence of breathing.

• No pulse.

The steps in performing CPR in pediatric resuscitation are as follows:

• Check if the child is alert or not. Gently tap the child. Assess whether the child is awake, conscious, or making some noise. Then shout, “Are you okay?”

• If the child does not respond, call for help by shouting. Ask someone to call and inform the local emergency department to get a medical team and an AED at the earliest. The child should not be left alone until CPR is done.

• Carefully make the child lie on his/her back. If a spinal injury is suspected, care should be taken not to move the child’s head and neck.

• Then chest compressions are given.

• Place the heel of one palm on the breastbone (sternum) located just below the nipples. Either one hand is used, or two hands are used, depending on the child’s size. Care has to be taken to not place the heel of the hand on the very end part of the breastbone.

• Place your other hand over the child’s forehead to keep the head tilted back.

• Compress the child’s chest to about one-third (4 centimeters) or half the depth (5 centimeters) of the chest size.

• Give 30 chest compressions with the chest rising completely after each compression. The compressions should be fast and powerful and given continuously without breaks.

• Counting from 1 to 30 while giving compressions will help perform it better.

• To open the airway, lift the chin using one hand. Simultaneously, tilt the head back by pushing the forehead down with the other hand.

• Assess the child’s signs of breathing by placing your ear close to the mouth and nose. Look for chest movements.

• With the absence of breathing, cover the child’s mouth with your mouth and pinch the nose to close the nasal openings.

• Position the child’s chin up and head tilted back and give two rescue breaths with each breath for 1 second and see the chest rise.

• If the child remains unresponsive after 2 minutes of CPR, with no movement or breathing, call the local emergency number for help and use an AED if available.

• Repeat the steps of chest compressions and rescue breathing till you notice some recovery in the child or until the medical team arrives with help. When one rescuer is present, for every 30 chest compression, two rescue breaths are given. When two rescuers are there, each rescuer gives two breaths for every 15 chest compression.

• When the child moves and starts breathing back, keep them in a recovery position and monitor their breathing until a rescue team arrives.

• Do not move the head or the neck if the child suffers a spinal injury. Do not start with chest compression if the child is breathing normally.

How Is Sodium Bicarbonate Used in Pediatric CPR?

• The use of sodium bicarbonate in cardiac arrest in children has been a controversial topic.

• A cardiac arrest causes hypoxia (low oxygen supply to the tissues) and hypoperfusion (reduced blood flow to organs), which results in metabolic acidosis (high levels of acids in the body fluids). This leads to weakened heart contractions, a decrease in the efficiency of antihypertensive drugs (vasopressors), and a risk of developing ventricular dysrhythmias.

• Previously, according to advanced cardiovascular life support (ACLS) guidelines, sodium bicarbonate was administered to alleviate the effects.

• But sodium bicarbonate administration has some harmful effects like hyperosmolarity (high amount of sodium in the blood which can draw out water from organs), increase in vascular resistance, compensatory respiratory acidosis (high levels of carbon dioxide in lungs), and reduced ionized calcium concentration.

• Sodium bicarbonate is recommended now in selected cases of cardiac arrest that occur secondary to hyperkalemia(higher potassium levels), tricyclic antidepressants toxicity, and preexisting metabolic acidosis.

• However, still, sodium bicarbonate is routinely used during cardiac arrest to manage metabolic acidosis.

Conclusion:

The use of sodium bicarbonate is limited in pediatric cardiac arrest. The routine use of sodium bicarbonate is not advised according to ACLS guidelines. More evidence and research are needed to interpret the effectiveness of sodium bicarbonate during the management of pediatric patients.