Comparison of THAM and sodium bicarbonate in resuscitation of the heart after ventricular fibrillation in dogs.

Anesthesia & Analgesia (Impact Factor: 3.3). 01/1977; 56(1):38-45. DOI: 10.1213/00000539-197701000-00012
Source: PubMed

ABSTRACT Tris (hydroxymethyl) aminomethane (tromethamine or THAM) has been suggested as an effective substitute for sodium bicarbonate (NaHCO3) in the treatment of metabolic acidosis accompanying cardiac arrest. Even though several reports on its appraisal have been published, there is still no clear agreement on its therapeutic value. A double-blind study was therefore lndertaken to compare in 36 dogs the effectiveness of 0.6 M THAM, 0.3 M THAM, and NaHCO3 (0.892 mEq/ml) to correct metabolic acidosis produced during 3 minutes of cardiac fibrillation, followed by a 3-minute period of cardiac compression. The dogs were then defibrillated and observed for 45 minutes. One group of 8 dogs was treated with 0.9 percent NaCl infusion. Compared with 0.9 percent NaCl, both THAM and NaHCO3 were equally effective in correcting metabolic acidosis (p less than 0.05). Initially, 0.6 M THAM produced a more pronounced (p less than 0.05) elevation of blood pH, but this effect was not sustained during the later postdefibrillation period. There was little difference in the effect of either of these drugs on mean aortic pressure and total peripheral vascular resistance. It is concluded that adequate ventilation and effective cardiac compression are still the chief criteria on which the final outcome of cardiac resuscitation depends. Correction of metabolic acidosis is important supportive therapy, but either THAM or NaHCO3 can be used with comparatively equivalent effect.

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    ABSTRACT: The buffer therapy of acid-base changes during CPR is less controversial than in previous years. Overwhelming experimental and some clinical data failed to demonstrate an improvement in survival after buffer therapy. However, the scant data from randomized controlled trials still impede a clear-cut recommendation on how really to treat cardiopulmonary resuscitation (CPR)-associated acid-base changes.
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    ABSTRACT: Buffer therapy, especially sodium bicarbonate (SB), is still one of the most controversial issues in cardiopulmonary resuscitation. This critical review focuses around four issues: 1) the necessity of buffer therapy, 2) evidence for its beneficial effects, 3) evidence for its detrimental effects, and 4) differences among the various available buffers. The major conclusions of this review are: 1) significant, deleterious metabolic acidosis often exists at the time that drugs (epinephrine) are initiated during cardiopulmonary resuscitation. 2) Although clinical evidence is lacking, buffer therapy is probably beneficial when used in conjunction with effective ventilation and measures to optimize tissue perfusion. 3) No substantial evidence shows a detrimental effect of buffer therapy, specifically sodium bicarbonate; if appropriately used, sodium bicarbonate does not increase serum sodium and osmolarity, does not interfere with oxygen release, does not increase tissue carbon dioxide concentrations, and does not paradoxically worsen intracellular acidosis. 4) Despite theoretic differences, there is not enough factual basis to favor the use of other buffers over sodium bicarbonate. Prospective clinical trials and more laboratory research using relevant experimental models are badly needed to resolve the important controversy over buffer therapy in cardiopulmonary resuscitation.
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