A 47-year-old man presented to the emergency department with out-of-hospital cardiac arrest. The patient had a previous history of heart transplantation with implantable cardioverter defibrillator (ICD). Ventricular fibrillation persisted despite 18 minutes of standard advanced cardiac life support at the emergency department. He received intravenous administration of 68 meq sodium bicarbonate and subsequent return of spontaneous circulation was noted after correction of acidosis with sodium bicarbonate in prolonged cardiac arrest.