Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Feb 1;52(2):e67-e78.
doi: 10.1097/CCM.0000000000006089. Epub 2023 Nov 3.

Sodium Bicarbonate and Calcium Chloride for the Treatment of Hyperkalemia-Induced Cardiac Arrest: A Randomized, Blinded, Placebo-Controlled Animal Study

Mark Andreas Eggertsen  1   2 , Cecilie Munch Johannsen  1   2 , Alexander Kovacevic  2 , Mikael Fink Vallentin  3 , Lauge Mørk Vammen  1   2 , Lars W Andersen  1   2   3 , Asger Granfeldt  1   2
Affiliations

Sodium Bicarbonate and Calcium Chloride for the Treatment of Hyperkalemia-Induced Cardiac Arrest: A Randomized, Blinded, Placebo-Controlled Animal Study

Mark Andreas Eggertsen et al. Crit Care Med. .

Abstract

Objectives: Current international guidelines recommend administrating calcium chloride and sodium bicarbonate to patients with hyperkalemia-induced cardiac arrest, despite limited evidence. The aim of this study was to evaluate the efficacy of calcium chloride and sodium bicarbonate on return of spontaneous circulation (ROSC) in a pig model of hyperkalemia-induced cardiac arrest.

Design: A randomized, blinded, placebo-controlled experimental pig study. Hyperkalemia was induced by continuous infusion of potassium chloride over 45 minutes followed by a bolus. After a no flow period of 7 minutes, pigs first received 2 minutes of basic cardiopulmonary resuscitation and subsequently advanced life support. The first intervention dose was administered after the fifth rhythm analysis, followed by a defibrillation attempt at the sixth rhythm analysis. A second dose of the intervention was administered after the seventh rhythm analysis if ROSC was not achieved. In case of successful resuscitation, pigs received intensive care for 1 hour before termination of the study.

Setting: University hospital laboratory.

Subjects: Fifty-four female Landrace/Yorkshire/Duroc pigs (38-42 kg).

Interventions: The study used a 2 × 2 factorial design, with calcium chloride (0.1 mmol/kg) and sodium bicarbonate (1 mmol/kg) as the interventions.

Measurements and main results: Fifty-two pigs were included in the study. Sodium bicarbonate significantly increased the number of animals achieving ROSC (24/26 [92%] vs. 13/26 [50%]; odds ratio [OR], 12.0; 95% CI, 2.3-61.5; p = 0.003) and reduced time to ROSC (hazard ratio [HR] 3.6; 95% CI, 1.8-7.5; p < 0.001). There was no effect of calcium chloride on the number of animals achieving ROSC (19/26 [73%] vs. 18/26 [69%]; OR, 1.2; 95% CI, 0.4-4.0; p = 0.76) or time to ROSC (HR, 1.5; 95% CI, 0.8-2.9; p = 0.23).

Conclusions: Administration of sodium bicarbonate significantly increased the number of animals achieving ROSC and decreased time to ROSC. There was no effect of calcium chloride on the number of animals achieving ROSC or time to ROSC.

PubMed Disclaimer

Conflict of interest statement

Dr. Granfeldt’s institution received funding from NMD Pharma; he received funding from Noorik Pharmaceuticals; and he was supported by a grant from the Health Research Foundation of Central Denmark Region. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Comment in

References

    1. Wong CX, Brown A, Lau DH, et al.: Epidemiology of sudden cardiac death: Global and regional perspectives. Heart Lung Circ. 2019; 28:6–14
    1. Wallmuller C, Meron G, Kurkciyan I, et al.: Causes of in-hospital cardiac arrest and influence on outcome. Resuscitation. 2012; 83:1206–1211
    1. Alfonzo A, Soar J, MacTier R, et al.: Clinical Practice Guidelines: Treatment of Acute Hyperkalaemia in Adults. UK Renal Association, 2020. Available at: https://ukkidney.org/health-professionals/guidelines/treatment-acute-hyp... . Accessed October 30, 2023
    1. Lott C, Truhlář A, Alfonzo A, et al.; ERC Special Circumstances Writing Group Collaborators: European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances. Resuscitation. 2021; 161:152–219
    1. Batterink J, Cessford TA, Taylor RAI: Pharmacological interventions for the acute management of hyperkalaemia in adults. Cochrane Database Syst Rev. 2015; 10:CD010344