Sodium Bicarbonate for In-Hospital Cardiac Arrest: A Randomized Clinical Trial. (Therapy)
Granfeldt A, et al. JAMA. 2026 Aug 25;336(8):647-654. doi: 10.1001/jama.2026.10628.
Editorial: Will the Bicarbonate for In-Hospital Cardiac Arrest Trial Change Practice?
Callaway CW. JAMA. 2026 Aug 25;336(8):639-641. doi: 10.1001/jama.2026.10508.
Methodology: 4/5
Usefulness: 4/5
Question and Methods: Multicentre double-blind RCT examining whether routine sodium bicarbonate improves sustained ROSC versus saline placebo in adults with epinephrine-treated in-hospital cardiac arrest.
Findings: Sustained ROSC was similar with bicarbonate versus placebo (39% vs 37%; adjusted RR 1.05, 95% CI 0.88–1.24; P=.62).
Limitations: Modified intention-to-treat analysis excluded 14.7% after randomization, and the trial was underpowered to detect differences in survival or neurological outcomes.
Interpretation: Routine empiric bicarbonate should not be used in adult in-hospital cardiac arrest, while established indication-specific uses such as hyperkalemia remain appropriate.
