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Impact of calcium administration on survival and neurologic outcomes in adults with in-hospital cardiac arrest

Julia Hawthorne1, Saman Razzaq1, Chelsey Malhas1

  • 1Department of Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States.

Resuscitation Plus
|August 15, 2026
PubMed

Insights

Calcium administration during in-hospital cardiac arrest (IHCA) was linked to worse patient outcomes. This study found lower rates of sustained return of spontaneous circulation and survival in patients receiving calcium during resuscitation.

Area of Science:

  • Cardiology
  • Critical Care Medicine
  • Clinical Research

Background:

  • Calcium administration in cardiac arrest lacks strong evidence of benefit.
  • Previous studies suggest potential harm in out-of-hospital cardiac arrest.
  • Limited data exist on calcium's impact during in-hospital cardiac arrest (IHCA).

Purpose of the Study:

  • To evaluate the association between intravenous calcium gluconate administration and outcomes in adult IHCA.
  • To determine if calcium use impacts sustained return of spontaneous circulation (ROSC), survival, and neurological outcomes.

Main Methods:

  • Retrospective cohort study of adult IHCA events (2011-2024) at a US academic medical center.
  • Included IHCA events lasting at least 5 minutes.
  • Analyzed intravenous calcium gluconate administration as the primary exposure, with sustained ROSC, survival, and neurological outcome as primary/secondary endpoints using multivariable logistic regression.

Main Results:

  • Calcium was administered in 39.1% of 599 IHCA events.
  • Calcium use was associated with significantly lower rates of sustained ROSC (31.6% vs 57.8%), survival to discharge (6.8% vs 18.9%), and favorable neurological outcome (3.0% vs 14.3%).
  • Multivariable analysis confirmed calcium use was independently associated with poorer outcomes (ORs ranging from 0.20 to 0.46).

Conclusions:

  • Intravenous calcium administration during IHCA is independently associated with reduced rates of sustained ROSC, survival, and favorable neurological outcomes.
  • Findings support current guidelines advising against routine calcium use in undifferentiated IHCA.
  • Further research may clarify specific patient subgroups who could potentially benefit from calcium therapy.
Abstract

Keywords:
CalciumCardiac arrestIn-hospital cardiac arrestMortalityNeurologic outcomeOutcomeReturn of spontaneous circulationSurvival

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