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Is Calcium Effective During a Cardiac Arrest?

December 27, 2021

Written by Jonathan Brewer

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Among adults with an out-of-hospital cardiac arrest, providing IV or IO calcium does not significantly improve sustained return of spontaneous circulation (ROSC) when compared to IV/IO saline.

Why is this important?
When one thinks of our common ACLS medications, calcium chloride is commonly circulated around. We often ask for “1 gram of calcium chloride,” but are we benefiting our patients?

“It’s just calcium…right?”
This was a double-blind, placebo-controlled, randomized clinical trial with 397 adult patients that sustained out-of-hospital cardiac arrest in Denmark.  Patients were given up to 2 IV or IO doses with 5 mmol of calcium chloride (approximately 725 mg of calcium chloride dihydrate) vs 9 mg/mL of sodium chloride. The trial was actually halted early due to concerns about harm in the calcium group; 391 were included out of a planned sample size of 674.

37 patients (19%) in the calcium group had sustained ROSC compared to 53 patients (27%) in the saline group. At 30 days, 10 patients (5.2%) in the calcium group and 18 patients (9.1%) in the saline group were still alive with a favorable neurologic outcome in 7 patients (3.6%) of the calcium group vs 15 patients (7.6%) in the saline group. Based on these findings, the authors concluded that treatment with IV/IO calcium did not significantly improve sustained ROSC when compared to placebo.

While some may argue that the dose given was not equivalent to what we often give during a cardiac arrest, according to the American Heart Association, multiple retrospective and prospective studies in the cardiac arrest setting have not shown benefit from the use of calcium. They further explain that calcium could theoretically be detrimental, so they recommend it only be used in specific scenarios such as suspected hyperkalemia or calcium channel blocker toxicity.

I don’t know about you but I may start thinking twice before I ask for “1 gram of calcium” during a cardiac arrest.

Effect of Intravenous or Intraosseous Calcium vs Saline on Return of Spontaneous Circulation in Adults With Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA. 2021 Dec 14;326(22):2268-2276. doi: 10.1001/jama.2021.20929.

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