Routine Bicarb for Shock or Cardiac Arrest?

While metabolic acidosis is common in critical illness, studies to date have not shown a clear benefit of supplementing sodium bicarbonate (bicarb) in patients with shock requiring vasopressors or in patients during cardiac arrest. Despite the lack of evidence, bicarb is often administered to these patients. Two double-blind randomized trials now investigate whether IV sodium bicarbonate improves outcomes in patients with shock or cardiac arrest (Figure 1).