Cardiac Arrest: Buffer therapy had no clear effect on discharge from hospital.

Clinical bottom line (level 1b-)

  1. Patients who had an out of hospital cardiac arrest and were treated with buffer therapy as compared with placebo, had no clear difference in hospital discharge rates.
  2. There was no clear effect on admission to ICU.
Dybvik et al: Resuscitation 1995; 29: 89-95
Expires October 2003

The study

Double-blinded concealed randomised trial with intention-to-treat
Setting: City, Norway

502 patients (aged mean 65 years, 76% male) out of hospital cardiac arrest and persistent ventricular defibrillation after first defibrillation attempt or asystole

Excluded if
  • <16 years
  • hypothermia
  • cardiac arrest of obvious non-cardiac origin (posttraumatic, drowning, drug overdose etc)
  • post-randomisation exclusions were made (prior to unblinding) with postmortem identified non-cardiac arrests


    • Control Group: (n = 257, 257 analysed): 250ml of 0.9% normal saline
    Experimental Group: (n = 245, 245 analysed): Tribonat-250ml consisting of sodium bicarbonate 160mmol/l, trometamol 300 mmol/l, disodium phosphate 20 mmol/l, acetate 200 mmol/l
    osmolality of buffer 750 mosmol/l, pH 8.1, buffer capacity 500 mmol/l
    100% followed for ?

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNH
    (95% CI)
    admission to ICU hours 92
    (35.8%)    		 87
    (35.5%)    		 -1.00%
    (-22% to 25%)    		 -0.29%
    (-8.67% to 8.09%)    		 348
    (NNT = 12 to infinity;
    NNH = 12 to infinity)
    discharge from hospital weeks 35
    (13.6%)    		 24
    (9.80%)    		 -28.0%
    (-56.0% to 17.0%)    		 -3.82%
    (-9.43% to 1.78%)    		 26
    (NNT = 56 to infinity;
    NNH = 11 to infinity)

    Comments

    1. The study is too small to show any clear differences.
    2. Advanced life support was performed according to American Heart Association and European Resuscitation Council guidelines.
    3. The post-randomisation exclusion of non-cardiac arrests should further increase the ability of buffer to produce a difference in effect - biasing the results positively - yet still no benefit is seen.

    Citation

    1. Dybvik T, Strand T, Steen PA: Buffer therapy during out-of-hospital cardiopulmonary resuscitation.. Resuscitation 1995; 29: 89-95
    Contributor: Clare Wotton and Bob Phillips, October 1999
    Reviewer: Kenneth Ballew

    Clinical Question.
    Patient out of hospital cardiac arrest
    Intervention or Exposure buffer therapy
    Outcome discharge from hospital