Bicarbonate for In-Hospital Cardiac Arrest

Conditions

Cardiac Arrest

Brief summary

This is an investigator-initiated, multicenter, randomized, placebo-controlled, parallel group, double-blind, superiority trial of sodium bicarbonate during adult in-hospital cardiac arrest. There will be 22 enrolling sites in Denmark. 778 adult patients with in-hospital cardiac arrest receiving at least one dose of adrenaline will be enrolled. The primary outcome is return of spontaneous circulation and key secondary outcomes include survival at 30 days and survival at 30 days with a favorable neurological outcome.

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, Andersen LPK, 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, Henschel W, Walli AR, Sandgaard M, Asferg CL, Ciubotariu A, Rasmussen MHR, Le Breton V, Nielsen LK, Hansen FG, Brændstrup N, Thomsen IK, Sindberg B, Andersen LW, Bicarbonate for In-Hospital Cardiac Arrest (BIHCA) Investigators.

2026-06-11

10.1001/jama.2026.10628

Interventions

DRUGSodium bicarbonate

Sodium bicarbonate 1 mmol/ml

DRUGSodium chloride

Sodium chloride 9 mg/mL

Study design

Allocation

RANDOMIZED

Intervention model

PARALLEL

Primary purpose

TREATMENT

Masking

QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)

Eligibility

Sex/Gender

ALL

Age

18 Years to No maximum

Healthy volunteers

No

Inclusion criteria

1. In-hospital cardiac arrest 2. Age ≥ 18 years 3. Received at least one dose of adrenaline during cardiopulmonary resuscitation (CPR)

Exclusion criteria

1. Clearly documented "do-not-resuscitate" order prior to the cardiac arrest 2. Prior enrollment in the trial 3. Invasive mechanical circulatory support at the time of the cardiac arrest 4. Known or suspected pregnancy at the time of the cardiac arrest 5. Known objection by the patient to participate in the trial 6. Clinical indication for bicarbonate administration

Design outcomes

Primary

Measure	Time frame	Description
Number of Participants With Return of Spontaneous Circulation	During the cardiac arrest, an average of 20 minutes	Return of spontaneous circulation is defined as spontaneous circulation with no further need for chest compressions sustained for at least 20 minutes

Secondary

Measure	Time frame	Description
Number of Participants That Survived 30 Days	At 30 days	—
Number of Participants With a Favorable Neurological Outcome at 30 Days	At 30 days	A favorable neurological outcome will be defined as a modified Rankin Scale score of 0, 1, 2 or 3. The modified Rankin Scale is a 7-point scale assessing neurological/functional outcomes after brain damage with higher scores indicating worse neurological/functional outcomes.

Countries

Denmark

Contacts

PRINCIPAL_INVESTIGATORLars W Andersen

Aarhus University Hospital

Outcome results

None listed