Although many studies have shown little/no benefit and perhaps harm from administration of SB for rapid correction of acidemia accompanying cardiac arrest, and the latest ACLS guidelines published by the AHA do not recommend routine administration, SB is still used as part of resuscitation in cardiac arrest.

According to the AHA, sodium bicarbonate is not indicated for routine use in cardiac arrest victims. It is well-known that cardiac arrest induces a state of metabolic acidosis. However, to use this drug, acidosis should be proved with an arterial sample and an ABG. Sodium bicarbonate is a direct myocardial depressant and its use during resuscitation should be restricted to proved cases of metabolic acidosis. Moreover, sodium bicarbonate has interactions with many drugs. It is physically incompatible with amiodarone, cisatracurium, haloperidol, midazolam and thiopental.

No role of sodium bicarbonate in ACLS but there is role in case of ckd or in case of tca toxicity