RecentRCT

BIHCA

Sodium Bicarbonate for In-Hospital Cardiac Arrest: A Randomized Clinical Trial

JAMA, 2026 · Double-blind placebo-controlled trial at 21 Danish hospitals

Population: Adults with in-hospital cardiac arrest after at least one epinephrine dose; 913 randomized, 779 eligible for primary analyses
Intervention: IV sodium bicarbonate, up to 100 mmol
Comparator: Placebo
Primary outcome: Sustained return of spontaneous circulation
Result: 39% versus 37%; RR 1.05 (95% CI 0.88–1.24), P=.62. Alkalosis and hypernatremia were more common with bicarbonate.

What the trial found

Routine bicarbonate did not significantly improve sustained ROSC.

Clinical interpretation

Does not support routine bicarbonate during in-hospital arrest. Specific hyperkalemia or sodium-channel blocker poisoning indications require separate assessment.

Limitations

Post-randomization exclusions; primary endpoint was ROSC, not adequately powered long-term neurologic survival.

Moderate certainty

Clinical Context & Relevant Topics (1)

Disease Reference

Metabolic Acidosis: HAGMA, NAGMA, & Bicarbonate Evidence

Differential diagnosis (GOLD MARK vs HARDCARP), toxic alcohol osmolar gaps, Urine Anion Gap, and current sodium bicarbonate evidence including BICAR-ICU and BICARICU-2.

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