Clinical Outcomes of Fluid Resuscitation with Sodium Bicarbonate Ringer’s Solution in Patients with Hemorrhagic Shock: A Systematic Review and Meta-analysis

Abstract Sodium bicarbonate Ringer’s (SBR) solution is a novel crystalloid solution that has been demonstrated to improve metabolic acidosis caused by shock. Emerging evidence suggests that SBR could be a more effective therapeutic option in the context of hemorrhagic shock. Hence, this study aimed to compare the efficacy of SBR solution to the traditional crystalloids in hemorrhagic shock patients. We searched on PubMed, Scopus, and Cochrane Central for all relevant randomized clinical trials. Our review included all studies comparing the clinical outcomes of SBR solution to lactated Ringer’s solution or normal saline in hemorrhagic shock. There were two primary outcomes: mortality and shock-related complications in addition to mean arterial pressure (MAP). Data were extracted and analyzed using Review Manager Software (RevMan version 5.4). Our analysis included three studies that compared SBR to normal saline or lactated Ringer’s. No significant effect was observed for the intervention neither on MAP (mean difference [MD] = 1.08, 95% confidence interval [CI] [ −0.91, 3.08], P = 0.49) nor the mortality (relative risk [RR] = 0.61, 95% CI [0.36, 1.05], P = 0.83). For adverse events, a significant difference was observed for acute respiratory distress syndrome and multi-organ failure, with RR values of −0.13 and 0.38, respectively. Additionally, the SBR group had significantly decreased intensive care unit (ICU) length of stay (MD = −1.43, 95% CI [−2.07, −0.79], P > 0.00001). No observed effect was found on hospitalization days or developing disseminated intravascular coagulopathy. SBR is safe and effective for hemorrhagic shock resuscitation and has better outcomes in terms of ICU length of stay and hospitalization days with less complications. However, it has similar outcomes compared to the lactated Ringer’s and normal saline regarding the mortality and MAP. Further studies are needed with larger sample size to assess the long-term follow-up and side effects. Prospero registered on October 8 with ID CRD42023467595.