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- W4386985039 abstract "We read with great interest the article by Niederberger et al.,1Niederberger S.M. Crowe R.P. Salcido D.D. Menegazzi J.J. Sodium bicarbonate administration is associated with improved survival in asystolic and PEA Out-of-Hospital cardiac arrest.Resuscitation. 2023; 182109641https://doi.org/10.1016/j.resuscitation.2022.11.007Google Scholar which analyzed the impact of sodium bicarbonate administration on outcomes in out-of-hospital cardiac arrest (OHCA). Given the ongoing debate and conflicting evidence surrounding the use of sodium bicarbonate in this patient population, we appreciate the authors’ effort to bring clarity to this complex issue. The authors found that sodium bicarbonate administration was associated with improved rates of survival to hospital discharge in patients with an initial presenting rhythm of asystole (bicarb 3.3% vs control 2.4%; p = 0.020) or pulseless electrical activity (PEA) (bicarb 8.1% vs control 5.4%; p = 0.034). The scale of this study and the significance of its findings have the potential to shift clinical practice towards the administration of sodium bicarbonate in cases of asystolic and PEA cardiac arrest. However, further comment and clarity regarding the study’s methodology may be necessary. The authors briefly mention that their study population was limited to non-traumatic cardiac arrest patients of cardiac etiologies, leading to the exclusion of 14,355 cases attributed to non-cardiac causes. The criteria for classification of cardiac etiologies are not outlined in the study. Further, determining the etiology of cardiac arrest in the field can be challenging, particularly without access to detailed medical history or diagnostic tools. In 1991, the American Heart Association (AHA), in collaboration with various other organizations, initially recommended classifying cardiac arrests into either cardiac or non-cardiac etiologies for standardized OHCA reporting, known as the “Utstein Style”.2Cummins R.O. Chamberlain D.A. Abramson N.S. Allen M. Baskett P.J. Becker L. et al.Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council.Circulation. 1991; 84: 960-975https://doi.org/10.1161/01.CIR.84.2.960Google Scholar This reporting guideline has evolved over time and in 2015 the AHA revised the Utstein template recommending against such differentiation, citing substantial subjectivity in the literature when attempting to distinguish between cardiac and non-cardiac causes of arrest.3Perkins G.D. Jacobs I.G. Nadkarni V.M. Berg R.A. Bhanji F. Biarent D. et al.Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the utstein resuscitation registry templates for out-of-hospital cardiac arrest.Circulation. 2015; 132: 1286-1300https://doi.org/10.1161/CIR.0000000000000144Google Scholar Existing literature investigating cardiac arrest etiology often demonstrates that a minority of cases are attributable to cardiac causes. For instance, Chen et al. identified cardiac etiology in only 28.3% of their non-traumatic, OHCA patient population,4Chen N. Callaway C.W. Guyette F.X. Rittenberger J.C. Doshi A.A. Dezfulian C. et al.Arrest etiology among patients resuscitated from cardiac arrest.Resuscitation. 2018; 130: 33-40https://doi.org/10.1016/j.resuscitation.2018.06.024Google Scholar and Moriwaki et al. identified 42.7% of such cases in their study group.5Moriwaki Y. Tahara Y. Kosuge T. Suzuki N. Etiology of out-of-hospital cardiac arrest diagnosed via detailed examinations including perimortem computed tomography.J Emergencies Trauma Shock. 2013; 6: 87https://doi.org/10.4103/0974-2700.110752Google Scholar The exclusion of a broad category of patients that appear to represent the majority of cardiac arrest cases, defined in a manner prone to subjectivity, could introduce bias and limit the study’s reproducibility. This is particularly concerning given the extensive number of contradictory findings in existing literature, as highlighted by the authors. Thus, it may be beneficial to include non-cardiac etiologies of cardiac arrest in this study’s analysis, which could provide more comprehensive and generalizable results. Jesse Albano: Conceptualization, Writing – original draft, Writing – review & editing. Todd M. Conner: Writing – review & editing. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper." @default.
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- W4386985039 date "2023-10-01" @default.
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- W4386985039 title "Does sodium bicarbonate significantly improve survival in asystolic and PEA out-of-hospital cardiac arrest?" @default.
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