In which of the following cardiac arrest scenarios does current ACLS recommend administration of sodium bicarbonate?

• A Prolonged arrest with downtime exceeding 10 minutes
• B Refractory ventricular fibrillation after three shocks
• C Routine use after the second dose of adrenaline
• D Cardiac arrest associated with tricyclic antidepressant overdose ✓

Explanation

Sodium bicarbonate is reserved for specific situations: pre-existing metabolic acidosis, hyperkalemia, and poisoning by sodium channel blockers such as tricyclic antidepressants. Routine use in prolonged arrest is not recommended because it worsens intracellular acidosis and causes hypernatremia and hyperosmolarity, which eliminates option A and C. It has no antiarrhythmic role in refractory VF.

Reference: AHA Guidelines for CPR and Emergency Cardiovascular Care, 2020 ed.

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Written and medically reviewed by the StethoPrep medical team.