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

Asger Granfeldt; Bertram Lahn Kirkegaard; Mikael Fink Vallentin; Mathias J Holmberg; Nikola Stankovic; Peter Carøe Lind; Anders Gade Kjærgaard; Nanna Houe; Matias Vested; Dan Lou Isbye; Camilla Meno Kristensen; Jesper Kjærgaard; Stine Thorhauge Zwisler; Søren Nygaard Lundsfryd; Louise Breum Petersen; Fredrik Folke; Carolina Malta Hansen; Kasper Karmark Iversen; Morten Schou; Sebastian Wiberg; Signe Juul Riddersholm; Bodil Steen Rasmussen; Kristine Karlsson; Ronni R Plovsing; Christian Svendsen Juhl; Mette Krag; Christian Dalby Sørensen; Peter Kuhne-Qvist; Jakob Oxlund; Christoffer Grant Sølling; Jacob Robsahm Hansen; Lars Peter Kloster Andersen; Jimmi Malmberg Scheel Jensen; Theis Skovsgaard Itenov; Marlene Lauritzen; Malthe Jessen Pedersen; Rasmus Philip Nielsen; Hans Fjeldsøe-Nielsen; Naqibullah Mirzada; Niels Secher; Ulrick Skipper Espelund; Jennifer Rosenkjær Eskol; Kasper Andersen; Anne Craveiro Brøchner; Helene Korvenius Nedergaard; Peter Martin Hansen; Lars Wiuff Andersen; Bicarbonate for In-Hospital Cardiac Arrest (BIHCA) Investigators

doi:10.1001/jama.2026.10628

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

Asger Granfeldt^*
, Bertram Lahn Kirkegaard
, Mikael Fink Vallentin
, Mathias J Holmberg
, Nikola Stankovic
, Peter Carøe Lind
, Anders Gade Kjærgaard
, Nanna Houe
, Matias Vested
, Dan Lou Isbye
, Camilla Meno Kristensen
, Jesper Kjærgaard
, Stine Thorhauge Zwisler
, Søren Nygaard Lundsfryd
, Louise Breum Petersen
, Fredrik Folke
, Carolina Malta Hansen
, Kasper Karmark Iversen
, Morten Schou
, Sebastian Wiberg

Signe Juul Riddersholm, Bodil Steen Rasmussen, Kristine Karlsson, Ronni R Plovsing, Christian Svendsen Juhl, Mette Krag, Christian Dalby Sørensen, Peter Kuhne-Qvist, Jakob Oxlund, Christoffer Grant Sølling, Jacob Robsahm Hansen, Lars Peter Kloster Andersen, Jimmi Malmberg Scheel Jensen, Theis Skovsgaard Itenov, Marlene Lauritzen, Malthe Jessen Pedersen, Rasmus Philip Nielsen, Hans Fjeldsøe-Nielsen, Naqibullah Mirzada, Niels Secher, Ulrick Skipper Espelund, Jennifer Rosenkjær Eskol, Kasper Andersen, Anne Craveiro Brøchner, Helene Korvenius Nedergaard, Peter Martin Hansen, Lars Wiuff Andersen, Bicarbonate for In-Hospital Cardiac Arrest (BIHCA) Investigators

^*Kontaktforfatter

Aarhus Universitetshospital
Københavns Universitet
Rigshospitalet
Odense Universitetshospital
Herlev og Gentofte Hospital
Aalborg Universitetshospital
Aalborg Universitet
Amager og Hvidovre Hospital
Holbæk Sygehus
Syddansk Universitet
Regionshospitalet Viborg
Sjællands Universitetshospital
Frederiksberg og Bispebjerg Hospital
Gødstrup Hospital
Regionshospitalet Horsens
Aarhus Universitet

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Abstract

IMPORTANCE: Patients with in-hospital cardiac arrest have poor outcomes. Sodium bicarbonate is commonly administered during cardiac arrest, but the effects on clinical outcomes are unknown.

OBJECTIVE: To determine whether administration of sodium bicarbonate during in-hospital cardiac arrest increases the proportion of patients with return of spontaneous circulation.

DESIGN, SETTING, AND PARTICIPANTS: Randomized, parallel-group, double-blind, placebo-controlled clinical trial conducted at 21 hospitals in Denmark. Participants were adults with in-hospital cardiac arrest, who received at least 1 dose of epinephrine. Patients were enrolled from February 6, 2023, to February 11, 2026, with the last 90-day follow-up conducted on May 4, 2026. Final statistical analysis was conducted on May 5, 2026.

INTERVENTION: Sodium bicarbonate (up to 100 mmol) or placebo intravenously.

MAIN OUTCOMES AND MEASURES: The primary outcome was sustained return of spontaneous circulation. Key secondary outcomes were survival at 30 days and survival at 30 days with a favorable neurologic outcome, defined by a score of 0 to 3 on the modified Rankin Scale (scores range from 0 to 6, with higher scores indicating greater disability).

RESULTS: A total of 2913 patients with in-hospital cardiac arrest were screened; 913 patients were randomized, of which 779 were eligible for the primary analyses, with 372 randomized to receive sodium bicarbonate and 407 randomized to receive placebo. The median (IQR) age of patients was 73 (64-79) years and 502 were male (64%). Sustained return of spontaneous circulation occurred in 146 patients (39%) in the sodium bicarbonate group and 150 (37%) in the placebo group (risk ratio, 1.05 [95% CI, 0.88-1.24]; P = .62). At 30 days, 45 patients (12%) in the sodium bicarbonate group and 37 (9.1%) in the placebo group were alive (risk ratio, 1.25 [95% CI, 0.84-1.88]); a favorable neurologic outcome at 30 days occurred in 30 patients (8.1%) and 22 patients (5.4%), respectively (risk ratio, 1.39 [95% CI, 0.82-2.34]). Alkalosis and hypernatremia after cardiac arrest were more common in the sodium bicarbonate group.

CONCLUSIONS AND RELEVANCE: There was no significant difference in sustained return of spontaneous circulation between sodium bicarbonate and placebo in adults with in-hospital cardiac arrest. These findings do not support routine administration of sodium bicarbonate for patients with in-hospital cardiac arrest.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05564130; ClinicalTrialsRegister.eu Identifier: 2022-501304-10-00.

Originalsprog	Engelsk
Tidsskrift	JAMA
Vol/bind	336
Udgave nummer	8
Sider (fra-til)	647-654
ISSN	0098-7484
DOI	https://doi.org/10.1001/jama.2026.10628
Status	Udgivet - 25. aug. 2026

Dokumenter og links

10.1001/jama.2026.10628

SDU link

Tjek adgangen til materialet i Syddansk Universitetsbiblioteks søgemaskine

Citationsformater

Granfeldt, A., Kirkegaard, B. L., Vallentin, M. F., Holmberg, M. J., Stankovic, N., Lind, P. C., Kjærgaard, A. G., Houe, N., Vested, M., Isbye, D. L., Kristensen, C. M., Kjærgaard, J., Zwisler, S. T., Lundsfryd, S. N., Petersen, L. B., Folke, F., Hansen, C. M., Iversen, K. K., Schou, M., ... Bicarbonate for In-Hospital Cardiac Arrest (BIHCA) Investigators (2026). Sodium Bicarbonate for In-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA, 336(8), 647-654. https://doi.org/10.1001/jama.2026.10628

@article{7cd705a97da14576ad843803a235e5e9,

title = "Sodium Bicarbonate for In-Hospital Cardiac Arrest: A Randomized Clinical Trial",

abstract = "IMPORTANCE: Patients with in-hospital cardiac arrest have poor outcomes. Sodium bicarbonate is commonly administered during cardiac arrest, but the effects on clinical outcomes are unknown.OBJECTIVE: To determine whether administration of sodium bicarbonate during in-hospital cardiac arrest increases the proportion of patients with return of spontaneous circulation.DESIGN, SETTING, AND PARTICIPANTS: Randomized, parallel-group, double-blind, placebo-controlled clinical trial conducted at 21 hospitals in Denmark. Participants were adults with in-hospital cardiac arrest, who received at least 1 dose of epinephrine. Patients were enrolled from February 6, 2023, to February 11, 2026, with the last 90-day follow-up conducted on May 4, 2026. Final statistical analysis was conducted on May 5, 2026.INTERVENTION: Sodium bicarbonate (up to 100 mmol) or placebo intravenously.MAIN OUTCOMES AND MEASURES: The primary outcome was sustained return of spontaneous circulation. Key secondary outcomes were survival at 30 days and survival at 30 days with a favorable neurologic outcome, defined by a score of 0 to 3 on the modified Rankin Scale (scores range from 0 to 6, with higher scores indicating greater disability).RESULTS: A total of 2913 patients with in-hospital cardiac arrest were screened; 913 patients were randomized, of which 779 were eligible for the primary analyses, with 372 randomized to receive sodium bicarbonate and 407 randomized to receive placebo. The median (IQR) age of patients was 73 (64-79) years and 502 were male (64\%). Sustained return of spontaneous circulation occurred in 146 patients (39\%) in the sodium bicarbonate group and 150 (37\%) in the placebo group (risk ratio, 1.05 [95\% CI, 0.88-1.24]; P = .62). At 30 days, 45 patients (12\%) in the sodium bicarbonate group and 37 (9.1\%) in the placebo group were alive (risk ratio, 1.25 [95\% CI, 0.84-1.88]); a favorable neurologic outcome at 30 days occurred in 30 patients (8.1\%) and 22 patients (5.4\%), respectively (risk ratio, 1.39 [95\% CI, 0.82-2.34]). Alkalosis and hypernatremia after cardiac arrest were more common in the sodium bicarbonate group.CONCLUSIONS AND RELEVANCE: There was no significant difference in sustained return of spontaneous circulation between sodium bicarbonate and placebo in adults with in-hospital cardiac arrest. These findings do not support routine administration of sodium bicarbonate for patients with in-hospital cardiac arrest.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05564130; ClinicalTrialsRegister.eu Identifier: 2022-501304-10-00.",

author = "Asger Granfeldt and Kirkegaard, \{Bertram Lahn\} and Vallentin, \{Mikael Fink\} and Holmberg, \{Mathias J\} and Nikola Stankovic and Lind, \{Peter Car{\o}e\} and Kj{\ae}rgaard, \{Anders Gade\} and Nanna Houe and Matias Vested and Isbye, \{Dan Lou\} and Kristensen, \{Camilla Meno\} and Jesper Kj{\ae}rgaard and Zwisler, \{Stine Thorhauge\} and Lundsfryd, \{S{\o}ren Nygaard\} and Petersen, \{Louise Breum\} and Fredrik Folke and Hansen, \{Carolina Malta\} and Iversen, \{Kasper Karmark\} and Morten Schou and Sebastian Wiberg and Riddersholm, \{Signe Juul\} and Rasmussen, \{Bodil Steen\} and Kristine Karlsson and Plovsing, \{Ronni R\} and Juhl, \{Christian Svendsen\} and Mette Krag and S{\o}rensen, \{Christian Dalby\} and Peter Kuhne-Qvist and Jakob Oxlund and S{\o}lling, \{Christoffer Grant\} and Hansen, \{Jacob Robsahm\} and \{Kloster Andersen\}, \{Lars Peter\} and Jensen, \{Jimmi Malmberg Scheel\} and Itenov, \{Theis Skovsgaard\} and Marlene Lauritzen and Pedersen, \{Malthe Jessen\} and Nielsen, \{Rasmus Philip\} and Hans Fjelds{\o}e-Nielsen and Naqibullah Mirzada and Niels Secher and Espelund, \{Ulrick Skipper\} and Eskol, \{Jennifer Rosenkj{\ae}r\} and Kasper Andersen and Br{\o}chner, \{Anne Craveiro\} and Nedergaard, \{Helene Korvenius\} and Hansen, \{Peter Martin\} and Andersen, \{Lars Wiuff\} and \{Bicarbonate for In-Hospital Cardiac Arrest (BIHCA) Investigators\}",

year = "2026",

month = aug,

day = "25",

doi = "10.1001/jama.2026.10628",

language = "English",

volume = "336",

pages = "647--654",

journal = "JAMA",

issn = "0098-7484",

publisher = "American Medical Association",

number = "8",

}

Granfeldt, A, Kirkegaard, BL, Vallentin, MF, Holmberg, MJ, Stankovic, N, Lind, PC, Kjærgaard, AG, Houe, N, Vested, M, Isbye, DL, Kristensen, CM, Kjærgaard, J, Zwisler, ST, Lundsfryd, SN, Petersen, LB, Folke, F, Hansen, CM, Iversen, KK, Schou, M, Wiberg, S, Riddersholm, SJ, Rasmussen, BS, Karlsson, K, Plovsing, RR, Juhl, CS, Krag, M, Sørensen, CD, Kuhne-Qvist, P, Oxlund, J, Sølling, CG, Hansen, JR, Kloster Andersen, LP, Jensen, JMS, Itenov, TS, Lauritzen, M, Pedersen, MJ, Nielsen, RP, Fjeldsøe-Nielsen, H, Mirzada, N, Secher, N, Espelund, US, Eskol, JR, Andersen, K, Brøchner, AC , Nedergaard, HK , Hansen, PM, Andersen, LW & Bicarbonate for In-Hospital Cardiac Arrest (BIHCA) Investigators 2026, 'Sodium Bicarbonate for In-Hospital Cardiac Arrest: A Randomized Clinical Trial', JAMA, bind 336, nr. 8, s. 647-654. https://doi.org/10.1001/jama.2026.10628

TY - JOUR

T1 - Sodium Bicarbonate for In-Hospital Cardiac Arrest

T2 - A Randomized Clinical Trial

AU - Granfeldt, Asger

AU - Kirkegaard, Bertram Lahn

AU - Vallentin, Mikael Fink

AU - Holmberg, Mathias J

AU - Stankovic, Nikola

AU - Lind, Peter Carøe

AU - Kjærgaard, Anders Gade

AU - Houe, Nanna

AU - Vested, Matias

AU - Isbye, Dan Lou

AU - Kristensen, Camilla Meno

AU - Kjærgaard, Jesper

AU - Zwisler, Stine Thorhauge

AU - Lundsfryd, Søren Nygaard

AU - Petersen, Louise Breum

AU - Folke, Fredrik

AU - Hansen, Carolina Malta

AU - Iversen, Kasper Karmark

AU - Schou, Morten

AU - Wiberg, Sebastian

AU - Riddersholm, Signe Juul

AU - Rasmussen, Bodil Steen

AU - Karlsson, Kristine

AU - Plovsing, Ronni R

AU - Juhl, Christian Svendsen

AU - Krag, Mette

AU - Sørensen, Christian Dalby

AU - Kuhne-Qvist, Peter

AU - Oxlund, Jakob

AU - Sølling, Christoffer Grant

AU - Hansen, Jacob Robsahm

AU - Kloster Andersen, Lars Peter

AU - Jensen, Jimmi Malmberg Scheel

AU - Itenov, Theis Skovsgaard

AU - Lauritzen, Marlene

AU - Pedersen, Malthe Jessen

AU - Nielsen, Rasmus Philip

AU - Fjeldsøe-Nielsen, Hans

AU - Mirzada, Naqibullah

AU - Secher, Niels

AU - Espelund, Ulrick Skipper

AU - Eskol, Jennifer Rosenkjær

AU - Andersen, Kasper

AU - Brøchner, Anne Craveiro

AU - Nedergaard, Helene Korvenius

AU - Hansen, Peter Martin

AU - Andersen, Lars Wiuff

AU - Bicarbonate for In-Hospital Cardiac Arrest (BIHCA) Investigators

PY - 2026/8/25

Y1 - 2026/8/25

N2 - IMPORTANCE: Patients with in-hospital cardiac arrest have poor outcomes. Sodium bicarbonate is commonly administered during cardiac arrest, but the effects on clinical outcomes are unknown.OBJECTIVE: To determine whether administration of sodium bicarbonate during in-hospital cardiac arrest increases the proportion of patients with return of spontaneous circulation.DESIGN, SETTING, AND PARTICIPANTS: Randomized, parallel-group, double-blind, placebo-controlled clinical trial conducted at 21 hospitals in Denmark. Participants were adults with in-hospital cardiac arrest, who received at least 1 dose of epinephrine. Patients were enrolled from February 6, 2023, to February 11, 2026, with the last 90-day follow-up conducted on May 4, 2026. Final statistical analysis was conducted on May 5, 2026.INTERVENTION: Sodium bicarbonate (up to 100 mmol) or placebo intravenously.MAIN OUTCOMES AND MEASURES: The primary outcome was sustained return of spontaneous circulation. Key secondary outcomes were survival at 30 days and survival at 30 days with a favorable neurologic outcome, defined by a score of 0 to 3 on the modified Rankin Scale (scores range from 0 to 6, with higher scores indicating greater disability).RESULTS: A total of 2913 patients with in-hospital cardiac arrest were screened; 913 patients were randomized, of which 779 were eligible for the primary analyses, with 372 randomized to receive sodium bicarbonate and 407 randomized to receive placebo. The median (IQR) age of patients was 73 (64-79) years and 502 were male (64%). Sustained return of spontaneous circulation occurred in 146 patients (39%) in the sodium bicarbonate group and 150 (37%) in the placebo group (risk ratio, 1.05 [95% CI, 0.88-1.24]; P = .62). At 30 days, 45 patients (12%) in the sodium bicarbonate group and 37 (9.1%) in the placebo group were alive (risk ratio, 1.25 [95% CI, 0.84-1.88]); a favorable neurologic outcome at 30 days occurred in 30 patients (8.1%) and 22 patients (5.4%), respectively (risk ratio, 1.39 [95% CI, 0.82-2.34]). Alkalosis and hypernatremia after cardiac arrest were more common in the sodium bicarbonate group.CONCLUSIONS AND RELEVANCE: There was no significant difference in sustained return of spontaneous circulation between sodium bicarbonate and placebo in adults with in-hospital cardiac arrest. These findings do not support routine administration of sodium bicarbonate for patients with in-hospital cardiac arrest.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05564130; ClinicalTrialsRegister.eu Identifier: 2022-501304-10-00.

AB - IMPORTANCE: Patients with in-hospital cardiac arrest have poor outcomes. Sodium bicarbonate is commonly administered during cardiac arrest, but the effects on clinical outcomes are unknown.OBJECTIVE: To determine whether administration of sodium bicarbonate during in-hospital cardiac arrest increases the proportion of patients with return of spontaneous circulation.DESIGN, SETTING, AND PARTICIPANTS: Randomized, parallel-group, double-blind, placebo-controlled clinical trial conducted at 21 hospitals in Denmark. Participants were adults with in-hospital cardiac arrest, who received at least 1 dose of epinephrine. Patients were enrolled from February 6, 2023, to February 11, 2026, with the last 90-day follow-up conducted on May 4, 2026. Final statistical analysis was conducted on May 5, 2026.INTERVENTION: Sodium bicarbonate (up to 100 mmol) or placebo intravenously.MAIN OUTCOMES AND MEASURES: The primary outcome was sustained return of spontaneous circulation. Key secondary outcomes were survival at 30 days and survival at 30 days with a favorable neurologic outcome, defined by a score of 0 to 3 on the modified Rankin Scale (scores range from 0 to 6, with higher scores indicating greater disability).RESULTS: A total of 2913 patients with in-hospital cardiac arrest were screened; 913 patients were randomized, of which 779 were eligible for the primary analyses, with 372 randomized to receive sodium bicarbonate and 407 randomized to receive placebo. The median (IQR) age of patients was 73 (64-79) years and 502 were male (64%). Sustained return of spontaneous circulation occurred in 146 patients (39%) in the sodium bicarbonate group and 150 (37%) in the placebo group (risk ratio, 1.05 [95% CI, 0.88-1.24]; P = .62). At 30 days, 45 patients (12%) in the sodium bicarbonate group and 37 (9.1%) in the placebo group were alive (risk ratio, 1.25 [95% CI, 0.84-1.88]); a favorable neurologic outcome at 30 days occurred in 30 patients (8.1%) and 22 patients (5.4%), respectively (risk ratio, 1.39 [95% CI, 0.82-2.34]). Alkalosis and hypernatremia after cardiac arrest were more common in the sodium bicarbonate group.CONCLUSIONS AND RELEVANCE: There was no significant difference in sustained return of spontaneous circulation between sodium bicarbonate and placebo in adults with in-hospital cardiac arrest. These findings do not support routine administration of sodium bicarbonate for patients with in-hospital cardiac arrest.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05564130; ClinicalTrialsRegister.eu Identifier: 2022-501304-10-00.

U2 - 10.1001/jama.2026.10628

DO - 10.1001/jama.2026.10628

M3 - Journal article

C2 - 42273960

SN - 0098-7484

VL - 336

SP - 647

EP - 654

JO - JAMA

JF - JAMA

IS - 8

ER -

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

Abstract

Dokumenter og links

SDU link

Fingeraftryk

Citationsformater