To compare the metabolic and hemodynamic parameters of cardiac surgery patients following the receipt of tris-hydroxymethyl aminomethane (THAM) or sodium bicarbonate alone for the treatment of postoperative metabolic acidosis.

Retrospective chart review.

Single, high-volume academic cardiac surgery center.

A total of 2,066 adult patients who underwent cardiac surgical procedures utilizing cardiopulmonary bypass were included.

The receipt of THAM or sodium bicarbonate within the first 12 hours following cardiac surgery.

The laboratory and hemodynamic parameters of cardiac surgery patients who received THAM or sodium bicarbonate for the treatment of metabolic acidosis were compared. Examples of these variables include pH, bicarbonate, PaCO₂, sodium, potassium, mean arterial pressure, and vasopressor needs. Secondary outcomes included acute kidney injury, mortality, mesenteric ischemia, and intensive care unit and hospital length of stay. THAM administration was associated with significantly higher pH and mean arterial pressure compared with sodium bicarbonate alone, without contributing to hypernatremia, hypercarbia, hyperkalemia, acute kidney injury, or mortality.