B54-13 To Bicarb or Not to Bicarb: Reducing Unnecessary Use of Sodium Bicarbonate During Cardiac Arrest to Improve Patient Outcomes

Background Routine administration of sodium bicarbonate during cardiac arrest is not supported by current American Heart Association (AHA) guidelines except for specific indications. Prior studies demonstrate no improvement in survival or neurologic outcomes and suggest possible harm. This quality-improvement (QI) initiative aimed to evaluate the real-world use of bicarbonate in in-hospital cardiac arrests and implement an educational intervention to promote evidence-based Advanced Cardiac Life Support (ACLS) practice. This study is the Phase 1 of QI project aimed at reducing the use of sodium bicarbonate in in hospital cardiac arrests and is the analysis of existing practices across UPMC Central PA hospital network. Methods A retrospective observational review of adult in-hospital cardiac arrests from 2021 to 2024 was conducted across 7 UPMC Central PA hospitals. Code documentation was reviewed for patient demographics, arrest characteristics (initial rhythm, shift timing), bicarbonate administration, and outcomes (return of spontaneous circulation [ROSC], survival to discharge) for 944 patients. Inclusion criteria were patients >/=18 years who underwent in-hospital cardiac arrest. Exclusion criteria were pregnant females, brain death, patients who received chest compressions for less than 2 minutes, trauma patients, out of hospital arrest. Descriptive statistics were generated in Excel; chi-square analyses were performed in R Studio. A pre-intervention knowledge survey and targeted educational session on guideline-directed use of bicarbonate were developed for Internal Medicine and Emergency Medicine residents. Post-intervention data collection is planned six months after implementation to assess practice and outcome changes. Results The population studied had a median age of 69.5 yrs. 59% were male. Median code duration was 17 minutes with mean of 53 minutes. 21% had an initial asystolic rhythm. 42% of cardiac arrests occurred at night. Overall survival was 28%. In 55% of cardiac arrests bicarbonate was used. Primary outcome i.e. survival was significantly higher in patients without bicarbonate use compared to patients with bicarbonate use, 40% vs 14.2% (p < 0.01). This was also redemonstrated in patients who had an initial non - asystolic rhythm i.e. survival was significantly higher in patients without Bicarbonate use compared to patients with bicarbonate use, 24.1% vs 7.7% (p < 0.01). These results indicate a higher propensity for bicarbonate use in cardiac arrest. Conclusion Routine sodium bicarbonate administration during cardiac arrest remains common despite guideline recommendations against its use. Early data from this QI project indicate an association between bicarbonate use and increased mortality. A structured educational intervention aims to improve adherence to evidence-based ACLS protocols and reduce unnecessary bicarbonate use. This abstract is funded by: none