Sodium bicarbonate administration in adult in-hospital cardiac arrest: propensity-score-weighted associations with sustained ROSC, 30-day survival and neurological outcomes

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Adult non-traumatic in-hospital cardiac arrest (IHCA) (n=2461). Intervention: Sodium bicarbonate (SB) administration during CPR vs. No sodium bicarbonate administration during CPR. Primary outcome: 30-day survival (propensity-score-weighted) (OR 0.96, 95% CI 0.66-1.39).

Q: What does this research mean for the field?

Sodium bicarbonate administration during CPR for adult in-hospital cardiac arrest is associated with increased sustained ROSC but does not improve 30-day survival or neurological outcomes. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Yixiao Xu; Lei Wang; Zhao Yang; Niandan Hu; Yuanyuan Zhang; Qiqi Luo; Qiyang Liang; Xiaotong Han; Lianhong Zou

doi:10.1186/s12873-026-01853-9

November 13, 2026BMC Emergency MedicineOpen Access

Sodium bicarbonate administration in adult in-hospital cardiac arrest: propensity-score-weighted associations with sustained ROSC, 30-day survival and neurological outcomes

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Key result

Sodium bicarbonate administration during CPR in adult IHCA was not associated with improved 30-day survival after propensity score weighting.

Why the study?

Sodium bicarbonate is frequently administered during resuscitation for in-hospital cardiac arrest, but supporting evidence for its clinical effectiveness is limited.

Does intra-arrest sodium bicarbonate administration during CPR improve 30-day survival, sustained ROSC, and favorable neurological outcomes in adult patients with non-traumatic in-hospital cardiac arrest?

Key Points

To evaluate the association between intra-arrest sodium bicarbonate administration and clinical outcomes, including 30-day survival, sustained ROSC, and neurological status, in adult in-hospital cardiac arrest.
Multicenter retrospective cohort study of 2,461 adult patients with non-traumatic in-hospital cardiac arrest across three tertiary hospitals in China between 2019 and 2022.
Patients were categorized by intra-arrest sodium bicarbonate administration (945 [38.4%] received the drug) during cardiopulmonary resuscitation.
Stabilized inverse probability of treatment weighting using propensity scores evaluated 30-day survival, sustained ROSC (≥20 minutes), and favorable neurological outcome (CPC 1–2 at discharge).
Before weighting, the sodium bicarbonate group had lower 30-day survival (6.2% vs. 9.4%; OR 0.64 [95% CI, 0.46–0.87]) and favorable neurological outcome (2.1% vs. 5.0%; OR 0.41 [95% CI, 0.24–0.67]), but higher sustained ROSC (34.3% vs. 30.5%; OR 1.19 [95% CI, 1.01–1.42]).
After propensity score weighting, sustained ROSC remained higher with sodium bicarbonate (44.4% vs. 27.3%; OR 2.12 [95% CI, 1.73–2.60]), while 30-day survival was comparable (7.5% vs. 7.8%; OR 0.96 [95% CI, 0.66–1.39]).
Favorable neurological outcome showed no significant difference between groups after weighting (2.6% vs. 4.1%; OR 0.62 [95% CI, 0.33–1.17]).

Study Design

Type

Cohort (n=2,461)

Multicenter

Yes

Structured PICO

Does intra-arrest sodium bicarbonate administration during CPR improve 30-day survival, sustained ROSC, and favorable neurological outcomes in adult patients with non-traumatic in-hospital cardiac arrest?

P

Population

2,461 adults (median age 68 years, 65% male) with non-traumatic in-hospital cardiac arrest receiving CPR across three tertiary hospitals in China, followed for 30 days.

E

Exposure

Intra-arrest sodium bicarbonate (SB) administration during CPR, given at the treating physician's discretion without a predefined protocol (n=945, 38.4%), alongside advanced life support according to current resuscitation guidelines.

C

Comparator

No sodium bicarbonate administration during resuscitation (non-SB group, n=1,516, 61.6%), receiving standard advanced life support according to current resuscitation guidelines.

O

Outcome

30-day survivalhard clinical

Main Result

Odds Ratio: 0.96 (95% CI 0.66–1.39)

Absolute Event Rate: 7.5% vs 7.8%

Intra-arrest sodium bicarbonate administration during CPR in adult in-hospital cardiac arrest patients is associated with higher rates of sustained ROSC but does not improve 30-day survival or favorable neurological outcomes, supporting against its routine use.

Limitations

Retrospective observational cohort design
Precise timestamps of sodium bicarbonate administration were unavailable
Total CPR duration and cumulative epinephrine dose used in the propensity score model unavoidably contained post-exposure information
Subgroups defined by final total CPR duration cannot guide real-time clinical treatment selection
Model-dependent behavior and discrepancy between frequentist and Bayesian estimates for sustained ROSC
Retrospective observational study design
Sodium bicarbonate administration was not guided by a predefined protocol and was determined at the treating physician's discretion
Total CPR duration and cumulative epinephrine dose used in the propensity-score model unavoidably contained post-exposure information
Subgroups defined by final total CPR duration are unknown at the time of intra-arrest delivery and cannot guide real-time clinical treatment selection

Ask about this paper

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Implication

No survival benefit seen after weighting in this observational cohort; leaves open whether RCTs are needed to assess sodium bicarbonate in adult IHCA.

Abstract

Sodium bicarbonate (SB) is frequently administered during resuscitation for in-hospital cardiac arrest (IHCA), although supporting evidence for its clinical effectiveness is limited. This study aimed to evaluate the association between SB administration and clinical outcomes in IHCA patients. We retrospectively analyzed adult patients with non-traumatic IHCA across three tertiary hospitals from January 2019 to December 2022. Propensity score-based approaches, prespecified subgroup analyses, weighted logistic regression models were used to assess the outcomes (30-d survival, sustained ROSC and favorable neurological outcome). Among 2,461 IHCA patients, 945 (38.4%) received SB. Before propensity score weighting, compared to non-SB group, the SB group had lower 30-day survival (6.2% vs. 9.4%; OR 0.64 [95% CI, 0.46–0.87]) and favorable neurological outcome (2.1% vs. 5.0%; OR 0.41 [95% CI, 0.24–0.67]), but higher sustained ROSC (34.3% vs. 30.5%; OR 1.19 [95% CI, 1.01–1.42]). After weighting, 30-day survival was comparable between groups (7.5% vs. 7.8%; OR 0.96 [95% CI, 0.66–1.39]), sustained ROSC remained higher in the SB group (44.4% vs. 27.3%; OR 2.12 [95% CI, 1.73–2.60]), and favorable neurological outcome showed no significant difference (2.6% vs. 4.1%; OR 0.62 [95% CI, 0.33–1.17]). Subgroup analyses indicated that SB improved sustained ROSC in patients with cardiopulmonary resuscitation (CPR) duration < 60 min, arrest occurring in ICU/general wards, respiratory/neurological/suspected cardiac causes, non-shockable rhythms, and without calcium administration. Conversely, CPR duration < 20 min, airway interventions, and non-antiarrhythmics administration were associated with worse neurological outcomes. SB administration during CPR in IHCA patients did not improve 30-d survival or neurological outcomes, despite being associated with higher rates of sustained ROSC. Routine SB use during CPR is not supported; improving post-resuscitation management may help translate the short-term benefit of facilitating sustained ROSC into long-term gains.

Discussion

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Cite This Study

Xu et al. (2026) conducted a cohort in Adult non-traumatic in-hospital cardiac arrest (IHCA) (n=2,461). Sodium bicarbonate (SB) administration during CPR vs. No sodium bicarbonate administration during CPR was evaluated on 30-day survival (propensity-score-weighted) (OR 0.96, 95% CI 0.66-1.39). Sodium bicarbonate administration during CPR in adult IHCA was not associated with improved 30-day survival after propensity score weighting.

synapsesocial.com/papers/6af9ebcdd393cbc380a04fc1 https://doi.org/10.1186/s12873-026-01853-9

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Sodium bicarbonate administration in adult in-hospital cardiac arrest: propensity-score-weighted associations with sustained ROSC, 30-day survival and neurological outcomes

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Sodium bicarbonate administration in adult in-hospital cardiac arrest: propensity-score-weighted associations with sustained ROSC, 30-day survival and neurological outcomes

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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