BIHCA Trial Journal Club
The BIHCA trial found routine sodium bicarbonate did not improve outcomes in in-hospital cardiac arrest. Review the evidence and implications with us!
The Journal of the American Medical Association (JAMA) published the BIHCA trial in June 2026. This post is a journal club breaking down the BIHCA trial and what change it may bring to our clinical practice.
Background/Overview
Title: Sodium Bicarbonate for In-Hospital Cardiac Arrest: A Randomized Clinical Trial
Citation: Granfeldt A, Kirkegaard BL, Vallentin MF, et al. Sodium Bicarbonate for In-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA. Published online June 11, 2026.
Objective: To determine whether administration of sodium bicarbonate during in-hospital cardiac arrest (IHCA) increases the proportion of patients with return of spontaneous circulation.
Background:
- Sodium bicarbonate has historically been used during cardiac arrest to treat severe metabolic acidosis.
- Current AHA and ERC guidelines recommend against routine use, except in select situations (e.g., hyperkalemia, tricyclic antidepressant overdose), because high-quality evidence has been lacking.
- Despite guideline recommendations, approximately half of U.S. in-hospital cardiac arrests receive sodium bicarbonate.
Primary Efficacy Measure: sustained return of spontaneous circulation, defined as a palpable pulse or other signs of circulation with no further need for chest compressions for at least 20 minutes.