Cardiac effects of carbon dioxide-consuming and carbon dioxide-generating buffers during cardiopulmonary resuscitation

Department of Medicine, University of Health Sciences, Chicago Medical School, Illinois 60064.

Recent studies have demonstrated an increase in carbon dioxide (CO2) tension (PCO2) in both mixed venous and coronary vein blood early in the course of cardiac arrest and cardiopulmonary resuscitation. Because increased PCO2 in the myocardium correlates with both ischemic injury and depression of contractile function, the effects of hypertonic solutions of either the CO2-"generating" sodium bicarbonate (NaHCO3) buffer, a mixture of sodium carbonate (Na2CO3) and sodium bicarbonate (carbicarb) acting as a CO2-"consuming" buffer, or saline placebo (NaCl) were compared during cardiopulmonary resuscitation in 25 healthy minipigs. Both buffer agents significantly increased the pH and HCO3- of arterial, mixed venous and coronary vein blood. Bicarbonate increased whereas carbicarb reduced blood PCO2 in the systemic circuit as anticipated. However, neither the PCO2 nor the lactate content of coronary vein blood was favorably altered by buffer therapy. Four of eight animals treated with bicarbonate, five of eight treated with carbicarb and six of nine placebo-treated animals were successfully resuscitated and had a comparable 24 h survival rate. Coronary perfusion pressure during precordial compression, a critical determinant of resuscitability, was transiently decreased by each of the hypertonic solutions. Accordingly, neither CO2-generating nor CO2-consuming buffers mitigated increases in coronary vein PCO2 or improved the outcome of cardiopulmonary resuscitation under these experimental conditions.

This article has been cited by other articles:

				I. M. Ayoub, J. Kolarova, Z. Yi, A. Trevedi, H. Deshmukh, D. L. Lubell, M. R. Franz, F. A. Maldonado, and R. J. Gazmuri Sodium-Hydrogen Exchange Inhibition During Ventricular Fibrillation: Beneficial Effects on Ischemic Contracture, Action Potential Duration, Reperfusion Arrhythmias, Myocardial Function, and Resuscitability Circulation, April 8, 2003; 107(13): 1804 - 1809. [Abstract] [Full Text] [PDF]

				A A J Adgey and P W Johnston Approaches to modern management of cardiac arrest Heart, October 1, 1998; 80(4): 397 - 401. [Full Text]

				Advanced Life Support Working Group of the Europea The 1998 European Resuscitation Council guidelines for adult advanced life support BMJ, June 20, 1998; 316(7148): 1863 - 1869. [Full Text]

				W. Tang, M. H. Weil, R. B. Schock, Y. Sato, J. Lucas, S. Sun, and J. Bisera Phased Chest and Abdominal Compression-Decompression: A New Option for Cardiopulmonary Resuscitation Circulation, March 4, 1997; 95(5): 1335 - 1340. [Abstract] [Full Text]

				P. C. Blahunka Pediatric Advanced Life Support (PALS): The Pharmacist's Role Journal of Pharmacy Practice, February 1, 1996; 9(1): 42 - 56. [Abstract] [PDF]

				Pediatric Advanced Life Support JAMA, October 28, 1992; 268(16): 2262 - 2275. [Abstract] [PDF]

				F. Kette, M. H. Weil, and R. J. Gazmuri Buffer Solutions May Compromise Cardiac Resuscitation by Reducing Coronary Perfusion Pressure JAMA, October 16, 1991; 266(15): 2121 - 2126. [Abstract] [PDF]

				M. L. Weisfeldt and A. D. Guerci Sodium Bicarbonate in CPR JAMA, October 16, 1991; 266(15): 2129 - 2130. [Abstract] [PDF]