JAMA
November 30, 2021
Effect of Intravenous or Intraosseous Calcium vs Saline on Return of Spontaneous Circulation in Adults With Out-of-Hospital Cardiac Arrest.
Mazen Kherallah
Summarized by:
What was the research question?
Does the administration of calcium during out-of-hospital cardiac arrest improve return of spontaneous circulation in adults?
How did they do it?
A double-blind, placebo-controlled randomized clinical trial in Denmark that included 397 adult patients with out-of-hospital cardiac arrest.
Patients randomized to receive either intravenous or intraosseous calcium (5 mmol up to 2 doses) (n=197) or saline (n=200), given after the first dose of epinephrine.
The primary outcome was sustained return of spontaneous circulation. The secondary outcomes included survival and a favorable neurological outcome (modified Rankin Scale score of 0-3) at 30 days and 90 days.
What did they find?
Sustained return of spontaneous circulation occurred was lower in the calcium group compared to the saline group (19% vs 27%; P = .09).
Percentage of alive patients at 30 days was lower in the calcium group compared to the saline group (5.2% vs 9.1%; P = .17).
A favorable neurological outcome at 30 days was lower in 3.6% in the calcium group compared to the saline group (3.6% vs 7.6%, P =0.12).
What are the limitations of the study?
The trial was stopped early due to concern of harm.
What does it mean?
Intravenous or intraosseous calcium did not improve the return of spontaneous circulation in patients with cardiac arrest with potential of harm.
Calcium should not be given to adult patients with out-of-hospital cardiac arrest.