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Kinetics and dynamics of ionized calcium in a porcine major trauma model
Dries Helsloot1, Arne Neyrinck, Hans Pottel
1Department of Emergency Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven University Campus Kulak, Kortrijk, Belgium; National Trauma Research Institute, Alfred Health and Monash University, Melbourne, VIC, Australia (D.H.); Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven University, University Hospitals Leuven, Leuven, Belgium (A.N.); Department of Public Health and Primary Care, KU Leuven University Campus Kulak, Kortrijk, Belgium (H.P.); National Trauma Research Institute, Alfred Health and Monash University, Melbourne, VIC, Australia; Trauma Service, The Alfred Hospital, Melbourne, VIC, Australia (C.G.); National Trauma Research Institute, Alfred Health and Monash University, Melbourne, VIC 3004, Australia; Trauma Service, The Alfred Hospital, Melbourne, VIC, Australia (J.K.M.); Department of Orthopedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany (D.O.); Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven University, Leuven, Belgium (D.V.B.); Department of Anesthesiology, AZ Groeninge Hospital, Kortrijk, Belgium (C.M.); Department of Cardiovascular Sciences, KU Leuven University Campus Kulak, Kortrijk, Belgium (S.F.D.M.); National Trauma Research Institute, Alfred Health and Monash University, Melbourne, VIC, Australia; Trauma Service, The Alfred Hospital, Melbourne, VIC Australia (M.F.).
Background:
Disturbances in ionized calcium (iCa²⁺) are common after major trauma and correlate parabolically with coagulopathy, transfusion, and mortality. However, the mechanisms underlying iCa²⁺ changes during trauma and resuscitation remain poorly understood. This exploratory study aimed to develop an experimental animal model to characterize the dynamics and kinetics of iCa²⁺ during trauma and resuscitation.
Methods:
A controlled porcine polytrauma model (PT, n=6)-including thoracic, abdominal, musculoskeletal trauma, controlled hemorrhage, and ischemia-reperfusion-was compared with nontrauma controls (C, n=4). Continuous hemodynamic monitoring and serial blood sampling during trauma, hemorrhage, ischemia-reperfusion, damage control resuscitation (DCR), transfusion, and observation enabled analysis of iCa²⁺ in relation to hemodynamic and acid-base status, ion interactions, and endocrine parameters.
Results:
Two animals in the polytrauma group died during the experiment and were excluded from analysis. Baseline iCa²⁺ levels were comparable between groups (C: 1.38 [95% CI: 1.36-1.41] vs. PT: 1.42 [95% CI: 1.35-1.49] mmol/L, p =0.211) and remained stable in controls. In the polytrauma group, iCa²⁺ initially increased with early respiratory acidosis following thoracic trauma, then progressively decreased during hemorrhagic shock and ischemia-reperfusion. A further rapid decrease followed transfusion of citrated autologous whole blood ( p <0.001). Phosphate, lactate, and magnesium increased during shock, while bicarbonate and albumin decreased. Parathyroid hormone peaked, whereas calcitonin and 25-hydroxy-Vit D reached their lowest levels at the nadir of hypocalcemia. iCa²⁺ recovered during DCR, returning to baseline by the end of observation ( t =240 min, 1.39 [1.30-1.47] mmol/L, p =0.593).
Conclusions:
iCa²⁺ changes dynamically during trauma and resuscitation, in parallel with alterations in acid-base status, circulating ions, transfusion, and endocrine responses. iCa²⁺ can spontaneously recover to baseline with adequate resuscitation without calcium supplementation. This exploratory study can contribute to the development of a robust experimental model for future translational research. ( J Trauma Acute Care Surg . 2026;101: 483-494. Copyright © 2026 The Author(s). Published by Wolters Kluwer Health, LLC. on behalf of the American Association for the Surgery of Trauma.).
