DENVER, April 22, 2022 – A new study examines the effect of rapid infusion of 2meq/kg of sodium bicarbonate (NaHCO3) in an ovine model on gas exchange and coronary and cerebral perfusion in the immediate post-resuscitation phase. Findings from the study will be presented during the Pediatric Academic Societies (PAS) 2022 Meeting, taking place April 21-25 in Denver.
Credit: Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
DENVER, April 22, 2022 – A new study examines the effect of rapid infusion of 2meq/kg of sodium bicarbonate (NaHCO3) in an ovine model on gas exchange and coronary and cerebral perfusion in the immediate post-resuscitation phase. Findings from the study will be presented during the Pediatric Academic Societies (PAS) 2022 Meeting, taking place April 21-25 in Denver.
NaHCO3 is not routinely recommended in neonates with metabolic acidosis. However, post-resuscitation and in infants with perinatal metabolic acidosis and hypoxic-ischemic encephalopathy, NaHCO3 continues to be used to correct acidosis. Rapid infusion of NaHCO3 can lead to carbon dioxide formation, myocardial injury and fluctuations of cerebral blood flow. The acute effects of rapid infusion of NaHCO3 on cerebral and coronary perfusion, especially post extensive neonatal resuscitation, remain unknown.
The study found that following extensive resuscitation, rapid NaHCO3 administration led to a significant rise in myocardial and cerebral perfusion along with higher levels of exhaled carbon dioxide. The effect of increased flow appears to be primarily due to changes in carbon dioxide levels. These acute changes could be detrimental especially during the reperfusion phase of ischemic injury post neonatal resuscitation.
“Despite the lack of evidence and concerns about its safety, NaHCO3 continues to be used in neonates with perinatal metabolic acidosis especially after extensive neonatal resuscitation,” said Mausma Bawa, MD, fellow physician at Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo. “We wanted to evaluate the effect of rapid infusion of NaHCO3 bolus in an ovine asphyxiated model in the immediate post-resuscitation phase on gas exchange and hemodynamics. In our study, we observed that post rapid NaHCO3 administration after extensive resuscitation, there was a significant rise in end tidal carbon dioxide levels, and significantly higher coronary and carotid blood flows. We speculate that in the setting of hypoxic ischemic injury, these higher blood flows to the brain and the heart could be detrimental especially during the reperfusion phase.”
Dr. Bawa will present “Rapid Bicarbonate Bolus Post Extensive Neonatal Resuscitation Leads to Increased Perfusion to the Heart and Brain” on Sunday, April 24 at 9:15 a.m. MDT. Reporters interested in an interview with Dr. Bawa should contact [email protected].
The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. For more information about the PAS Meeting, please visit www.pas-meeting.org.
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About the Pediatric Academic Societies Meeting
The Pediatric Academic Societies (PAS) Meeting is the premier North American scholarly child health meeting. The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. The PAS Meeting is produced through a partnership of four pediatric organizations that are leaders in the advancement of pediatric research and child advocacy: American Pediatric Society, Society for Pediatric Research, Academic Pediatric Association and American Academy of Pediatrics. For more information, please visit www.pas-meeting.org. Follow us on Twitter @PASMeeting, Instagram PASMeeting and #PAS2022, and like us on Facebook PASMeeting.
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Abstract: Rapid Bicarbonate Bolus Post Extensive Neonatal Resuscitation Leads to Increased Perfusion to the Heart and Brain
Presenting Author
Mausma Bawa, MD
Organization
Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
Topic
Neonatal Cardiac Physiology/Pathophysiology/Pulmonary Hypertension
Background
Sodium bicarbonate (NaHCO3) is not routinely recommended in neonates with metabolic acidosis. However, post-resuscitation and in infants with perinatal metabolic acidosis and hypoxic-ischemic encephalopathy (HIE), NaHCO3 continues to be used to correct acidosis. Rapid infusion of NaHCO3 can lead to carbon dioxide (CO2) formation, myocardial injury, and fluctuations of cerebral blood flow. The acute effects of rapid infusion of NaHCO3 on cerebral and coronary perfusion especially post extensive neonatal resuscitation remains unknown.
Objective
To study the effect of rapid infusion of 2meq/kg of NaHCO3 in an ovine model on 1) gas exchange 2) coronary and cerebral perfusion in the immediate post- resuscitation phase.
Design/Methods
Twelve near-term lambs (138-140d) at 1 hour post resuscitation for severe asphyxia were given 2meq/kg bicarb followed by 2ml flush via a central line. Blood gas parameters (pH), arterial carbon dioxide (PaCO2), arterial oxygenation (PaO2), base excess (BE), coronary blood flow (ml/kg/min), carotid blood flow (ml/kg/min) were recorded for 15 minutes before and after administration of
NaHCO3. We further delineated the lambs who received NaHCO3 to pH < 7.1 and pH ≥ 7.1. The effect of NaHCO3 with arterial carbon dioxide of < 35mmHg and >35mmHg was also analyzed.
Results
Eight lambs had pH < 7.1 and four had a pH ≥ 7.1 before administering NaHCO3 (Figure 1A). The gas exchange based on pH before and after NaHCO3 is represented in Figure 1B. There was a significant rise in exhaled CO2 levels (fig 1C) after NaHCO3 administration in all lambs and a significant change in PaCO2 in lambs with pH ≥7.1. Coronary and carotid blood flows after NaHCO3 (Figure 1C) administration were significantly higher. When comparing the impact of NaHCO3 in animals with PaCO2 < 35 or >35mmHg, we found that coronary, carotid and pulmonary flows were significantly higher when the PaCO2 was >35mmHg.
Conclusion(s)
Following extensive resuscitation, rapid NaHCO3 administration led to a significant rise in myocardial and cerebral perfusion along with higher levels of exhaled carbon dioxide. The effect of increased flow appears to be primarily due to changes in CO2 levels. These acute changes could be detrimental especially during the reperfusion phase of ischemic injury post neonatal resuscitation.
Tables and Images
Fig 1 Bicarb.jpg
Fig 2 Bicarb.jpg
Fig 3 Bicarb.jpg