Use of Sodium Bicarbonate During Pediatric Cardiac Admissions with Cardiac Arrest: Who Gets It and What Does It Do?

The objectives of this study were to characterize the use of sodium bicarbonate in pediatric cardiac admissions that experience cardiac arrest, to determine sodium bicarbonate use over the years, and to determine the impact of sodium bicarbonate on length of admissions, billed charges, and inpatient mortality. A cross-sectional study was conducted utilizing the Pediatric Health Information System database. Characteristics of admissions with and without sodium bicarbonate were initially compared by univariate analyses. The frequency by which sodium bicarbonate was used was compared by year. Regression analyses were conducted to determine the impact of sodium bicarbonate on length of stay, billed charges, and inpatient mortality. A total of 3987 (50.3%) of pediatric cardiac intensive care admissions with cardiac arrest utilized sodium bicarbonate; however, frequency changed from 62.1% in 2004 to 43.7% in 2015. Linear regression analysis demonstrated a decrease in length of stay (-27.5 days, < 0.01) and billed charges (-$470,906, < 0.01). Logistic regression analysis demonstrated an increase in mortality (odds ratio 1.77, 95% confidence interval 1.56-2.01). In conclusion, sodium bicarbonate is being used with less frequency over the last years in pediatric cardiac admissions with cardiac arrest. After adjustment for cardiac diagnoses, comorbidities, vasoactive medications, and other resuscitation medications, sodium bicarbonate is independently associated with increased mortality.