Historical collection · First published Jun 11, 2026; added to EM Weekly Oct 27, 2026. This retrospective summary may be superseded by later evidence or guidance.
← All articlesSodium Bicarbonate for In-Hospital Cardiac Arrest: A Randomized Clinical Trial
Summary
In this double-blind trial at 21 Danish hospitals, routine IV sodium bicarbonate did not improve sustained ROSC after in-hospital cardiac arrest. Of 913 randomized patients, 779 were eligible for the primary analysis.
Why it matters
The findings argue against routine empiric bicarbonate during in-hospital arrest. They do not resolve treatment for specific indications such as selected poisonings.
Study at a glance
- Design
- Randomized trial
- Population
- Adults with in-hospital arrest who had received at least one dose of epinephrine.
- Sample size
- 779
- Intervention
- Up to 100 mmol IV sodium bicarbonate.
- Comparator
- IV placebo.
- Primary endpoint
- Sustained return of spontaneous circulation.
Main findings
- Sustained ROSC: 39% versus 37%; RR 1.05 (95% CI 0.88-1.24).
- Thirty-day survival: 12% versus 9.1%; RR 1.25 (95% CI 0.84-1.88).
- Alkalosis and hypernatremia were more common with bicarbonate.
Limitations
Not powered to establish differences in survival or neurologic recovery. In-hospital arrest and postrandomization exclusions limit broader application.
Read the primary source
Full text: Abstract available; full text paywalled.
Original sourcePMID: 42273960
Material reviewed: abstract.
Source retrieved Oct 27, 2026. Abstract reviewed; full text unavailable. Publisher abstract and PubMed abstract reviewed. Publisher confirms June 11 first-online date. PMC manuscript was marked unavailable until December 11, 2026, so it was not treated as currently accessible.
Corrections & review history
No corrections recorded. Human review: not yet human-reviewed.