Category: Critical Care
Keywords: Calcium, Cardiac Arrest, ACLS, Code Blue (PubMed Search)
Posted: 8/16/2022 by Mark Sutherland, MD
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We previously posted on the COCA trial, which looked at empiric calcium administration in cardiac arrest. They studied 391 adult Danish cardiac arrest patients. The immediate and 30 day outcomes showed no benefit, and in fact strongly trended towards calcium being WORSE than placebo. This article provides the 6 month and 1 year follow up data. Surprise, surprise... calcium is still not looking good.
At 6 months survival non-significantly favored the placebo group, and at 1 year it significantly favored the placebo group. Neurologic outcome for those who survived was also no better, and perhaps slightly worse, in the calcium group.
Importantly, the trial excluded patients with "traumatic cardiac arrest, known or suspected pregnancy, prior enrollment in the trial, adrenaline prior to possible enrollment, and clinical indication for calcium at the time of randomization."
Bottom Line: The evidence continues to not support the routine empiric administration of calcium in cardiac arrest. Patients in whom there is an indication to give calcium (e.g. known ESRD, suspected hyperkalemia, etc) are excluded from these trials, and should likely still receive empiric calcium, but in undifferentiated cardiac arrest you can probably skip the calcium.
Vallentin MF, Granfeldt A, Meilandt C, Povlsen AL, Sindberg B, Holmberg MJ, Iversen BN, Mærkedahl R, Mortensen LR, Nyboe R, Vandborg MP, Tarpgaard M, Runge C, Christiansen CF, Dissing TH, Terkelsen CJ, Christensen S, Kirkegaard H, Andersen LW. Effect of calcium vs. placebo on long-term outcomes in patients with out-of-hospital cardiac arrest. Resuscitation. 2022 Jul 30;179:21-24. doi: 10.1016/j.resuscitation.2022.07.034. Epub ahead of print. PMID: 35917866.
