Sodium Bicarbonate Ringer's Solution for Hemorrhagic Shock: A Meta-analysis Comparing Crystalloid Solutions
Authors: Muhammad Ashir Shafique, Noman Adil Shaikh, Abdul Haseeb, Abdullah Mussarat, Muhammad Saqlain Mustafa
Published in: American Journal of Emergency Medicine, 2023 November 6
Background:
- The choice of fluid in Traumatic Hemorrhagic Shock (THS) is crucial for patient management. Bicarbonated Ringers Solution (BRS) is gaining attention due to its similarity to human extracellular fluid and potential hemodynamic benefits.
Conclusion:
- BRS showed a significant reduction in complications like adult respiratory distress syndrome (ARDS), Multiple Organ Dysfunction Syndrome (MODS), and total adverse effects compared to other crystalloids in treating THS.
- Patients treated with BRS exhibited a significant decrease in heart rate.
- BRS may improve organ stability and potentially enhance survival due to its composition resembling human extracellular fluid and minimal hepatic impact.
Method:
- Conducted a systematic literature review in Cochrane, EMBASE, MEDLINE, and PubMed.
- Predefined criteria were used to select studies and evaluate their quality.
- Key outcomes analyzed included survival rates, mortality, mean arterial pressure (MAP), heart rate (HR), and adverse events.
Result:
- Analysis of three studies indicated:
- Odds Ratio (OR) for survival with BRS use: 1.86 (95% CI: 0.94, 3.71; p = 0.08; I2 = 0%).
- OR for total adverse events: 0.14 (95% CI: 0.06, 0.35; p < 0.0001; I2 = 22%).
- Mean difference in HR: -4.49 (95% CI: -7.55, -1.44; p = 0.004; I2 = 13%).
- Mean difference in MAP: 2.31 (95% CI: -0.85, 5.47; p = 0.15; I2 = 66%).