Research ArticleResearchMedication SafetyNew Grad Friendly

Routine sodium bicarbonate did not improve return of circulation after in-hospital arrest

JAMA (PubMed)Aug 25, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

A multicenter randomized trial found sodium bicarbonate did not significantly increase sustained return of spontaneous circulation in adults with in-hospital cardiac arrest who had received epinephrine.

What NurseJet pulled from the source

Among 779 eligible randomized patients, sustained return of spontaneous circulation occurred in 39% with sodium bicarbonate and 37% with placebo. Thirty-day survival and favorable neurologic outcome estimates were imprecise and not significantly different. Alkalosis and hypernatremia after arrest were more common with bicarbonate.

Why this matters for nurses

Critical care and rapid-response nurses prepare and administer resuscitation medications while coordinating high-risk, time-sensitive care. This trial does not support routine bicarbonate during in-hospital cardiac arrest and reinforces attention to indication-specific algorithms and post-arrest electrolyte and acid-base monitoring.

Bedside takeaway

Routine bicarbonate did not improve sustained circulation, and alkalosis and hypernatremia were more common after arrest.

How This Applies in Practice

Use this when: Preparing or documenting medications during adult in-hospital cardiac arrest and subsequent post-arrest care.

On your shift

Follow the current resuscitation algorithm and confirm a protocol-defined indication or order before giving sodium bicarbonate.
Communicate and document the dose, route, timing, and clinical context during the resuscitation record.
During post-arrest care, monitor ordered sodium and acid-base results and report significant abnormalities.

Keep in mind: The trial addresses routine use, not every indication for bicarbonate. Follow the resuscitation protocol, facility policy, and provider orders.

Key takeaways

The double-blind trial included 779 eligible adults across 21 Danish hospitals.
Sustained return of spontaneous circulation was 39% with bicarbonate and 37% with placebo, a nonsignificant difference.
The trial did not show significant differences in 30-day survival or favorable neurologic outcome.
Post-arrest alkalosis and hypernatremia were more common in the bicarbonate group.

Practice implications

During a code, use sodium bicarbonate only within the approved resuscitation algorithm or a specific clinical indication and order. After administration, communicate the dose and timing and monitor ordered acid-base and sodium results during post-arrest care.

Limitations & cautions

The primary analysis excluded randomized patients later found ineligible, and the trial enrolled adults who had received at least one epinephrine dose in Danish hospitals. Confidence intervals for survival outcomes were wide, so the study does not exclude smaller benefits or harms in specific indications.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

Open source

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JAMA (PubMed)

JAMA (PubMed). Sodium Bicarbonate for In-Hospital Cardiac Arrest: A Randomized Clinical Trial.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42273960/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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A single-center retrospective cohort found that approximately one quarter of laboratory-defined acute kidney injury cases on internal medicine wards were not documented, particularly when maximal creatinine was lower.

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Among 161 adult hospitalizations meeting serum-creatinine criteria for acute kidney injury, 39 cases (24.2%) were undocumented. Length of stay and in-hospital mortality did not differ significantly by documentation status.

Key takeaways

In the 149 hospitalizations with a demonstrable creatinine change, 33 cases (22.1%) were undocumented.
Higher maximal creatinine was associated with lower adjusted odds of underdocumentation.
The study did not test whether a detection or documentation intervention improves care or outcomes.

Why this matters on shift

A smaller creatinine rise may receive less attention even when it meets the study's laboratory definition of acute kidney injury, which can affect how renal risk is communicated across the inpatient team.

Bedside takeaway

Trend ordered renal-function results and communicate clinically important changes through local escalation and documentation workflows.

Nursing implications

Trend ordered renal-function results and communicate clinically important changes through the care team according to local escalation and documentation workflows.

Limitations & cautions

Abstract-only summary. This was a retrospective, single-center study of 161 hospitalizations; urine-output criteria and reliable preadmission creatinine values were unavailable, and the reference creatinine method may affect case classification.
AI-summarized from the linked source. Review the original article before applying to practice.

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Renal failure (PubMed). Underdocumentation of laboratory-defined acute kidney injury in internal medicine wards: a retrospective cohort study.

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AI-summarized from the linked source. Review the original article before applying to practice.

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A double-blind randomized trial found no reduction in vomiting or faster oral tolerance with intravenous pantoprazole versus placebo in children with acute gastroenteritis and persistent vomiting after ondansetron.

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The trial randomized 100 children. Vomiting episodes and oral tolerance at 6 and 12 hours did not differ significantly, while median hospital stay was 2 days with pantoprazole and 1 day with placebo.

Key takeaways

The median participant age was 14 months, and 67% of participants were male.
Oral tolerance at 12 hours was 86% in both groups.
The longer stay associated with pantoprazole requires cautious interpretation because this was a single-center trial.

Why this matters on shift

The trial does not support empiric intravenous proton-pump inhibition for persistent vomiting in pediatric acute gastroenteritis after ondansetron.

Bedside takeaway

Clarify the indication for empiric acid suppression and keep hydration and oral-tolerance assessment central to care.

Nursing implications

Prioritize the ordered hydration and oral-tolerance plan, document ongoing emesis, and clarify the indication before administering empiric acid suppression.

Limitations & cautions

Abstract-only summary. This was a single-center study of 100 children in Tehran, and the abstract does not describe adverse events or explain why hospitalization was longer in the pantoprazole group.
AI-summarized from the linked source. Review the original article before applying to practice.

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European heart journal (PubMed)Sep 6, 2026Research Article

In the pragmatic TARGET-D randomized trial, vitamin D dosing titrated to a serum target did not significantly reduce the composite of death, recurrent myocardial infarction, heart-failure hospitalization, or stroke after myocardial infarction.

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Among 630 participants followed for an average of 4.2 years, major cardiovascular events occurred in 15.7% with targeted vitamin D management and 18.4% with usual care (hazard ratio 0.85, 95% CI 0.58 to 1.24; P=0.40).

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At baseline, 87% of participants had a 25-hydroxyvitamin D level of 40 ng/mL or lower.
The primary composite outcome and the individual outcomes of death, heart-failure hospitalization, and stroke were not significantly different.
A lower recurrent-MI rate was a secondary finding and should not override the nonsignificant primary result.

Why this matters on shift

The trial cautions against presenting targeted vitamin D supplementation as a proven strategy for reducing major cardiovascular events after myocardial infarction.

Bedside takeaway

Present vitamin D as prescribed supplementation, not as a replacement for established post-MI secondary prevention.

Nursing implications

Reinforce the prescribed secondary-prevention plan and avoid implying that vitamin D replaces therapies with established post-MI benefit.

Limitations & cautions

Abstract-only summary. The trial included 630 participants, 78.1% were men, the primary confidence interval included benefit and no benefit, and individual secondary outcomes were not the primary endpoint.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

European heart journal (PubMed). Targeted vitamin D supplementation and major adverse cardiovascular events after myocardial infarction: the TARGET-D trial.

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AI-summarized from the linked source. Review the original article before applying to practice.

How This Applies in Practice

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

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