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Calcium During a Code – It Can’t Hurt, Right?

September 1, 2022

Written by Jonathan Brewer

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IV calcium administration during CPR for pediatric in-hospital cardiac arrest (IHCA) was associated with worse survival and should be restricted to specific indications, as recommended by the American Heart Association (AHA).

Why does this matter?
IV calcium is commonly recommended during a code as a “life-saving” medication. However, studies conducted in the last few years have demonstrated that we may be causing more harm than benefit. So why do many still administer it?

“It can’t hurt them, right?”
This was a multicenter, retrospective cohort study that included 4,556 children with pre-existing heart disease that experienced an IHCA. After utilizing propensity score matching, children that received and did not received calcium during CPR were compared with the primary outcome of survival to hospital discharge.

Calcium was administered in 1,986 (44%) of patients and was usually given during longer durations of CPR (median 27 min [interquartile range (IQR): 10-50 min] vs 5 min [IQR: 2-16 min]; p < 0.001). However, it was associated with a decreased survival to hospital discharge (39% vs 46%; p = 0.02) even when adjusted for CPR duration, age, metabolic/electrolyte derangements, and illness category.

This was a great study but may not be truly applicable to most of our patient population in the emergency department (OHCA patients were excluded). However, based on prior studies analyzing calcium for OHCA and the AHA guidelines (that now recommend against routine administration of IV calcium during pediatric cardiac arrest), I would think twice about IV calcium during CPR unless there is a clinical indication.

Calcium Administration During Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest in Children With Heart Disease Is Associated With Worse Survival-A Report From the American Heart Association’s Get With The Guidelines-Resuscitation (GTWT-R) Registry. Pediatr Crit Care Med. 2022 Jul 27. doi: 10.1097/PCC.0000000000003040. Online ahead of print.