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Calcium during cardiac arrest: A systematic review

Cindy H Hsu1, Keith Couper2, Tyler Nix3

  • 1Department of Emergency Medicine, Weil Institute for Critical Care Research and Innovation, and Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA.

Resuscitation Plus
|April 7, 2023
PubMed

Insights

Routine calcium administration during cardiac arrest showed no benefit for adults or children. This systematic review found no evidence to support its use in improving survival or neurological outcomes in cardiac arrest patients.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Critical Care Medicine

Background:

  • Calcium plays a vital role in cardiac function, but its administration during cardiac arrest is controversial.
  • Evidence regarding the efficacy of routine calcium administration in improving outcomes for cardiac arrest patients is limited and conflicting.

Purpose of the Study:

  • To systematically review and synthesize evidence on the administration of calcium versus no calcium during cardiac arrest.
  • To evaluate the impact of calcium on return of spontaneous circulation, survival, neurological outcomes, and quality of life.

Main Methods:

  • A comprehensive systematic search was conducted across multiple databases (Medline, Embase, Cochrane, Web of Science, CINAHL Plus) up to September 30, 2022.
  • Included studies involved adult and pediatric patients experiencing cardiac arrest in any setting.
  • Risk of bias was assessed using Cochrane Risk of Bias 2 and ROBINS-I tools.

Main Results:

  • The review identified 4 studies (3 RCTs, 11 observational studies) involving over 20,000 patients.
  • Routine calcium administration did not improve outcomes in adult out-of-hospital cardiac arrest (OHCA), adult in-hospital cardiac arrest (IHCA), or pediatric IHCA.
  • Risk of bias was generally high, and certainty of evidence was moderate to low, precluding meta-analyses.

Conclusions:

  • This systematic review found no evidence supporting the routine administration of calcium during cardiac arrest in adults or children.
  • Current evidence suggests that calcium does not improve survival or neurological outcomes in these critical situations.
Abstract

Keywords:
Advanced Life SupportBasic Life SupportCalciumCardiac ArrestILCORSystematic Review

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