Cardiac arrest and blood ionized calcium levels

Blood ionized and total calcium levels, and pH values were obtained in 12 patients who were being ventilated and given external cardiac massage after having had an out-of-hospital cardiac arrest. On admission they had marked ionized hypocalcemia, with mean ionized calcium levels of 0.67 +/- 0.22 mmol/L, (range, 0.26 to 0.89), but normal total calcium levels. There was a positive correlation between pH and ionized calcium levels (r = 0.71). Of the six patients who were successfully resuscitated, four were discharged and two died; the other six could not be resuscitated and died. By comparison, ionized and total calcium levels obtained within 3 minutes of cardiac arrest were normal in 9 patients who had cardiac arrests in the intensive care unit or during surgery. All were discharged. These data are the first to document the occurrence of severe ionized hypocalcemia after out-of-hospital cardiac arrest. Hypocalcemia appears to be time-dependent and due essentially to extracellular complexing of calcium. Further work is needed to determine whether patients who have out-of-hospital cardiac arrests can benefit from calcium administration.