Role of sodium bicarbonate in cardiac surgery.pptx

recent updates of use of sodium bicarbonate in cardiac surgery

1. Role of sodium bicarbonate in cardiac surgery-recent trends Dr Abhinaba Sarkar Coronary fellow

2. 1 . Sodium bicarbonate (SB) administration has been considered an important part of treatment for severe metabolic acidosis in cardiac arrest 2. normalization of extracellular and intracellular pH was considered a meaningful endpoint of resuscitation 3. Correction of metabolic acidosis with SB was recommended by early advanced cardiac life support (ACLS) guidelines published in 1976 4. SB was the medication most frequently used during cardiac arrest until the mid-1980s 5. However, because of concerns regarding potential benefit vs. harm, SB use fell progressively to almost no use by 1991 , 6. At the present time, SB administration in cardiac arrest is controversial and matter of ongoing debate, and frequency of use varies greatly between medical centers 7.2010 ACLS/AHA guidelines- CLASS 3 recommendation 8. and these guidelines were not reviewed or revised in the last update published in 2015 and 2020

3. 1. leftward shift of the oxygen-hemoglobin dissociation curve - reduces the ability of hemoglobin to release oxygen to the tissues. 2. Alkalemia and Related Issues -Hypocalcemia,cardiac arrythmis,neurological dysfunction 3. Sodium bicarbonate solutions are hypertonic -causes major fluid shifts and electrolyte imbalances. 4. Paradoxical Acidosis - excessive bicarbonate reacts with hydrogen ions in the blood to produce carbon dioxide (CO2), which can then diffuse into cells.

4. Potential benefits ● Acidosis Correction ●Renal Protection ●Mitigating Ischemia-Reperfusion Injury Potential Harms and Concerns ● Increased Risk of Alkalemia ●Prolonged Ventilation and ICU Stay ●Conflicting Research ● Temporary measure

5. current indications AKI in sepsis Hyperkalemia Tricyclic antidepressant overdose Cardiotoxicity