Background: Human toxicity with aluminum phosphide (ALP) is usually associated with intense metabolic acidosis and cardiac ischemia which are the main cause of death. Aim of the study is to assess and compare the effectiveness of fresh packed RBCs and sodium bicarbonate in treatment of ALP toxicity. Methodology: This experimental study was conducted during the period from 1^st to 8^th March 2022 on 50 rats divided randomly into five groups: group I received Almond oil (control group), while the others were exposed to aluminum phosphide (12 mg/kg). Group III was given NaHCO₃ (3 mmol/kg), group IV received packed RBCs (1.5 ml) and group V was treated by both packed RBCs and NaHCO₃. Electrocardiogram, arterial blood gases, serum levels of cardiac troponin I, and histopathological examination of the heart were done for all rats. Results: ALP resulted in significant bradycardia (p=0.002), prolongation of QT interval (p<0.001), widening of QRS complex (p<0.001), elevation of ST segment (p<0.001), resistant metabolic acidosis (p<0.001) and increased troponin level (p<0.001). Histopathological examination revealed severe cardiac ischemic changes due to ALP exposure.  Packed RBCs + NaHCO₃ significantly improved bradycardia (p=0.025). Packed RBCs alone and packed RBCs plus NaHCO₃ significantly improved chemical and histopathological changes. However, the combination therapy demonstrated greater benefits compared to packed RBCs alone. Conclusion: These findings suggest using packed RBCs alone or with NaHCO3 to boost survival rates in ALP poisoning