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
Clinical Scorecard: Bicarbonate in Cardiac Arrest: Any Benefit?
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. Related Resources & Content
