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Abstract

Introduction: To evaluate the hemodynamic and oximetric changes in patients with parallel circulation (Norwood, hybrid, and BT-shunted) after sodium bicarbonate bolus administration. Methods: Retrospective analysis of physiologic data. To eliminate confounders, sodium bicarbonate boluses concurrently administered with normal saline, 5% albumin, epinephrine boluses, blood transfusions, change in VIS or mechanical circulatory support were excluded. Blood pressure, arterial oxygen saturation, heart rate, cerebral and renal NIRS were continuously recorded from one-hour pre to one-hour post each intervention. Results: Out of 429 boluses, 293 boluses met the inclusion criteria. Measurements show an increase in blood pressure (p = 0.01) and heart rate (p < 0.01), and a decrease in pulmonary-to-systemic flow ratio (p = 0.02) and renal oxygen extraction ratio (p = 0.04) at some point during the first hour post bolus. The arterial oxygen saturation increased, and the renal oxygen extraction ratio decreased for those patients with pre-bolus pH < 7.20 and/or pre-bolus serum bicarbonate level < 18 mEq/L, according to linear regression models (p < 0.05). Conclusions: Sodium bicarbonate was associated with improvement of hemodynamic and oximetric parameters in this cohort, particularly for those patients with pH < 7.20 and/or serum bicarbonate level < 18 mEq/L. This finding is consistent with an increase in cardiac output due to the removal of the acidotic negative inotropic effect by the sodium bicarbonate.

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