ICU Team Figures Out What Their Code Needs: More Bicarb!
NEW ORLEANS, LA – The ICU team at New Orleans Medical Center (NOMC) made history today by becoming the first medical team ever to implement a bicarb-only (More Bicarb!!) algorithm for cardiopulmonary arrest (see Figure 6 below). The bicarb-only code took place at 11:06 AM this morning behind partially-closed doors.
Bicarb (short for sodium bicarbonate and sometimes abbreviated SB) has always been controversial regarding its use in cardiac arrest. Current American Heart Association and the ACLS guidelines recommend against the routine use of bicarbonate. So if it’s not recommended, why use it?
“Look we’ve already gone to one end of the spectrum with chest compressions-only CPR, so we decided to go to the other end, test it out,” explained NOMC ICU attending Stephen Waters. “How does the bicarb-only code work? Simple: bicarb, bicarb, bicarb. Nothing else. No chest compressions, no epinephrine, no airway management. Just bicarb and more bicarb. It’s pretty easy, no effort at all.”
The literature suggests some circumstances in which bicarbonate might be useful: severe hyperkalemia and overdoses on tricyclic antidepressants. We asked Waters if the patient had either of those conditions.
“Definitely not,” he replied.
To be fair, the ICU team did obtain informed consent from the patient, who agreed for the purpose of furthering the sciences, knowledge, and medical research. Bless the man’s heart.
“That patient really put others before himself, an incredible man,” Waters explained to Gomerblog after the conclusion of the bicarbonate-only code. “Thanks to that patient, we have learned an incredible amount today, an INCREDIBLE amount. Thank you everyone for showing up today and lending us your support.”
So did it work?
“Good God no!!” blurted Waters, throwing his gloves into the garbage receptacle. “Bicarb’s f**king useless. USELESS. Why do we even make it any more?” He added later: “The patient’s pH does look reasonable, for whatever that’s worth.”