Review

.2022 Oct 8:12:100315.

doi: 10.1016/j.resplu.2022.100315. eCollection 2022 Dec.

Calcium use during cardiac arrest: A systematic review

Eduardo Messias Hirano Padrao¹, Brian Bustos¹, Ashwin Mahesh¹, Monaliza de Almeida Castro², Ravneet Randhawa¹, Christopher John Dipollina¹, Rhanderson Cardoso³, Prashant Grover⁴, Bruno Adler Maccagnan Pinheiro Besen^{5 6}

Affiliations

¹ Department of Medicine, University of Connecticut, Farmington, CT, USA.
² Universidade Nove de Julho, São Paulo, Brazil.
³ Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁴ Pulmonary and Critical Care Department, Saint Francis Hospital, Hartford, CT, USA.
⁵ Department of Medicine, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
⁶ Intensive Care Unit, Hospital A.C. Camargo Cancer Center, São Paulo, SP, Brazil.

PMID:36238582
PMCID: PMC9550532
DOI: 10.1016/j.resplu.2022.100315

Review

Calcium use during cardiac arrest: A systematic review

Eduardo Messias Hirano Padrao et al. Resusc Plus.2022.

.2022 Oct 8:12:100315.

doi: 10.1016/j.resplu.2022.100315. eCollection 2022 Dec.

Authors

Affiliations

¹ Department of Medicine, University of Connecticut, Farmington, CT, USA.
² Universidade Nove de Julho, São Paulo, Brazil.
³ Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁴ Pulmonary and Critical Care Department, Saint Francis Hospital, Hartford, CT, USA.
⁵ Department of Medicine, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
⁶ Intensive Care Unit, Hospital A.C. Camargo Cancer Center, São Paulo, SP, Brazil.

PMID:36238582
PMCID: PMC9550532
DOI: 10.1016/j.resplu.2022.100315

Abstract

Introduction: Calcium use during cardiac arrest has conflicting results in terms of efficacy. Therefore, we performed a systematic review evaluating the role of calcium administration in cardiac arrest.

Methods: We searched PubMed, Cochrane, and EMBASE for studies comparing calcium administration versus no calcium administration during cardiac arrest. The study was prospectively registered in PROSPERO (CRD42022316641) adhering to PRISMA guideline recommendations. The primary outcome was return of spontaneous circulation (ROSC) or survival at one hour. The secondary outcomes included survival to discharge or at 30 days, and favorable neurologic outcomes at 30 and 90 days. We planned to perform a random-effects meta-analysis of low risk of bias studies. We evaluated risk of bias with RoB-2 and ROBINS-I.

Results: We identified 1,921 articles and included ten studies with 2509 patients. We were not able to perform a meta-analysis with low-risk of bias studies as only one study was found to be at low-risk of bias. However, for the primary outcome, the three RCTs included showed no benefit with calcium administration during cardiac arrest for ROSC. For the secondary outcomes, based on the most recent study and lower risk of bias, there was a neutral effect for survival to discharge or at 30 days and neurologic outcomes at 30 days. However, there was unfavorable neurologic outcomes at 90 days.

Conclusion: Based on our results, calcium administration in cardiac arrests shows no benefit and can cause harm. Further studies on this matter are likely not advisable.

Keywords: Advanced Cardiac Life Support; Calcium; Cardiac arrest; Resuscitation.

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Conflict of interest statement

The authors declare that they have no conflict of interests.

Figures

**Fig. 1**
Flow diagram of study selection.

**Fig. 2**
Randomised Clinical Trials Risk of Bias (RoB2).

**Fig. 3**
Forest plot of return of spontaneous circulation or survival at one hour.

See this image and copyright information in PMC

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References

1. Kaay J.H., Blalock The use of calcium chloride in the treatment of cardiac arrest in patients. Surg Gynecol Obstet. 1951;93:97–102. - PubMed
1. Bers D.M. Calcium cycling and signaling in cardiac myocytes. Annu Rev Physiol. 2008;70:23–49. doi: 10.1146/annurev.physiol.70.113006.100455. - DOI - PubMed
1. JAMA. 1974;227:833–868. doi: 10.1001/jama.227.7.833. - DOI - PubMed
1. Harrison E.E., Amey B.D. The use of calcium in cardiac resuscitation. Am J Emerg Med. 1983;1:267–273. doi: 10.1016/0735-6757(83)90103-1. - DOI - PubMed
1. Stueven H., Thompson B.M., Aprahamian C., Darin J.C. Use of calcium in prehospital cardiac arrest. Ann Emerg Med. 1983;12:136–139. doi: 10.1016/s0196-0644(83)80551-4. - DOI - PubMed

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Calcium use during cardiac arrest: A systematic review

Affiliations

Calcium use during cardiac arrest: A systematic review

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

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