COCA Trial

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.

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.

COCA Trial