Bicarbonate in Cardiac Arrest: Any Benefit?

A first-of-its-kind randomized trial in in-hospital cardiac arrest found no statistically significant increase in sustained return of spontaneous circulation with sodium bicarbonate vs placebo.

By
Andrea Surnit
June 18, 2026
7 min

Conexiant

At a Glance

Category	Detail
Condition	In-Hospital Cardiac Arrest
Key Mechanisms	Sodium bicarbonate administration during resuscitation
Target Population	Adults aged 18 years or older with in-hospital cardiac arrest receiving epinephrine
Care Setting	In-hospital emergency care

Key Highlights

Sodium bicarbonate did not significantly increase sustained return of spontaneous circulation compared to placebo.
39% of patients in the sodium bicarbonate group achieved sustained return of spontaneous circulation versus 37% in the placebo group.
Survival at 30 days was 12% for sodium bicarbonate and 9% for placebo.
Alkalosis and hypernatremia were more common in the sodium bicarbonate group.
Current guidelines suggest against routine sodium bicarbonate use during cardiac arrest.

Guideline-Based Recommendations

Diagnosis

Patients with in-hospital cardiac arrest should be evaluated for eligibility for resuscitation trials.

Management

Routine administration of sodium bicarbonate during in-hospital cardiac arrest is not recommended.

Monitoring & Follow-up

Monitor for acid-base status and electrolyte imbalances during resuscitation.

Risks

Increased risk of alkalosis and hypernatremia with sodium bicarbonate administration.

Patient & Prescribing Data

Adults with in-hospital cardiac arrest receiving epinephrine.

Sodium bicarbonate was administered as a fixed dose due to feasibility concerns during cardiac arrest.

Clinical Best Practices

Follow current resuscitation guidelines regarding sodium bicarbonate use.
Consider individual patient circumstances before administering sodium bicarbonate.