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Early Calcium Replacement Is Associated With Reduced Mortality in Transfusion After Injury
Daniel Muchnok1, Allison Vargo2, Savannah Tollefson2
1Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
The Journal of Surgical Research
|July 23, 2026
Summary
Early calcium supplementation may reduce mortality in trauma patients requiring blood transfusions. This study suggests calcium administration during resuscitation could improve survival rates in severely injured individuals.
Area of Science:
- Trauma Resuscitation
- Critical Care Medicine
- Emergency Medicine
Background:
- Hemorrhage is a leading cause of trauma death.
- Hypocalcemia predicts mortality in severely injured patients receiving blood products.
- The role of calcium supplementation in trauma resuscitation is unclear.
Purpose of the Study:
- To evaluate the association between early calcium supplementation and mortality in trauma patients requiring blood transfusion.
- To investigate the impact of early calcium on hypocalcemia and hypercalcemia incidence.
- To determine if early calcium affects in-hospital mortality rates.
Main Methods:
- Retrospective cohort study (2010-2022) at a Level I trauma center.
- Included patients receiving >1 unit of blood product within 6 hours of injury.
- Defined early calcium as administration within 4 hours of the first transfused unit.
- Used multivariable logistic regression to analyze mortality association.
Main Results:
- Early calcium supplementation was associated with a 68% reduction in in-hospital mortality (aOR 0.32).
- Patients receiving early calcium had higher rates of hypocalcemia or hypercalcemia.
- Hypocalcemia correlated with blood product requirements, but early calcium did not.
Conclusions:
- Early calcium supplementation is linked to reduced mortality in trauma patients receiving early blood products.
- Findings support early calcium use in trauma resuscitation protocols.
- Further research is needed to optimize calcium regimens and understand underlying mechanisms.
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