Objective:

To evaluate the effect of sodium bicarbonate on sustained return of spontaneous circulation during in-hospital cardiac arrest.

Approach:

Key Findings:

• Sustained return of spontaneous circulation occurred in 39% of the sodium bicarbonate group and 37% of the placebo group.
• At 30 days, 12% of the sodium bicarbonate group and 9% of the placebo group were alive.
• Survival at 30 days with a favorable neurologic outcome occurred in 8% of the sodium bicarbonate group and 5% of the placebo group.
• Survival at 90 days was 11% in the sodium bicarbonate group and 8% in the placebo group.
• Survival at 90 days with a favorable neurologic outcome occurred in 9% of the sodium bicarbonate group and 7% of the placebo group.
• Sodium bicarbonate produced expected physiologic changes but did not improve clinical outcomes.
• Alkalosis and hypernatremia were more common in the sodium bicarbonate group.

Interpretation:

The trial found no statistically significant benefit of sodium bicarbonate on sustained return of spontaneous circulation or long-term outcomes in in-hospital cardiac arrest.

Limitations:

• The trial was powered for sustained return of spontaneous circulation rather than longer-term outcomes.
• Laboratory values could not be measured during cardiac arrest, leading to a heterogeneous population.
• The trial was conducted exclusively in Denmark, limiting generalizability.

Conclusion:

Routine administration of sodium bicarbonate during in-hospital cardiac arrest does not improve outcomes and is not supported by current guidelines.

Sources:

• Bicarbonate for In-Hospital Cardiac Arrest Trial
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