Calcium Administration During Weaning From Cardiopulmonary Bypass: A Narrative Literature Review

Ломиворотов, В. В.; Leonova, Elizaveta A.; Belletti, Alessandro; Shmyrev, Vladimir; Landoni, Giovanni

doi:10.1053/j.jvca.2019.06.016

Cited by 12 publications

(13 citation statements)

References 75 publications

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“…Due to adenosine triphosphate depletion during ischemia, sodium accumulates intracellularly, reducing the transmembrane sodium gradient and causing the sodium-calcium exchanger to operate in reverse mode. 30,31 High levels of calcium immediately after administration of calcium may have caused cytosolic and mitochondrial calcium overload during the cardiac arrest. This may have caused cardiac hypercontraction, a phenomenon termed stone heart.…”

Section: Discussionmentioning

confidence: 99%

Effect of Intravenous or Intraosseous Calcium vs Saline on Return of Spontaneous Circulation in Adults With Out-of-Hospital Cardiac Arrest

Vallentin

Granfeldt

Meilandt

et al. 2021

JAMA

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IMPORTANCEIt is unclear whether administration of calcium has a beneficial effect in patients with cardiac arrest. OBJECTIVE To determine whether administration of calcium during out-of-hospital cardiac arrest improves return of spontaneous circulation in adults. DESIGN, SETTING, AND PARTICIPANTSThis double-blind, placebo-controlled randomized clinical trial included 397 adult patients with out-of-hospital cardiac arrest and was conducted in the Central Denmark Region between January 20, 2020, and April 15, 2021. The last 90-day follow-up was on July 15, 2021. INTERVENTIONSThe intervention consisted of up to 2 intravenous or intraosseous doses with 5 mmol of calcium chloride (n = 197) or saline (n = 200). The first dose was administered immediately after the first dose of epinephrine. MAIN OUTCOMES AND MEASURESThe primary outcome was sustained return of spontaneous circulation. The secondary outcomes included survival and a favorable neurological outcome (modified Rankin Scale score of 0-3) at 30 days and 90 days. RESULTSBased on a planned interim analysis of 383 patients, the steering committee stopped the trial early due to concerns about harm in the calcium group. Of 397 adult patients randomized, 391 were included in the analyses (193 in the calcium group and 198 in the saline group; mean age, 68 [SD, 14] years; 114 [29%] were female). There was no loss to follow-up. There were 37 patients (19%) in the calcium group who had sustained return of spontaneous circulation compared with 53 patients (27%) in the saline group (risk ratio, 0.72 [95% CI, 0.49 to 1.03]; risk difference, −7.6% [95% CI, −16% to 0.8%]; P = .09). At 30 days, 10 patients (5.2%) in the calcium group and 18 patients (9.1%) in the saline group were alive (risk ratio, 0.57 [95% CI, 0.27 to 1.18]; risk difference, −3.9% [95% CI, −9.4% to 1.3%]; P = .17). A favorable neurological outcome at 30 days was observed in 7 patients (3.6%) in the calcium group and in 15 patients (7.6%) in the saline group (risk ratio, 0.48 [95% CI, 0.20 to 1.12]; risk difference, −4.0% [95% CI, −8.9% to 0.7%]; P = .12). Among the patients with calcium values measured who had return of spontaneous circulation, 26 (74%) in the calcium group and 1 (2%) in the saline group had hypercalcemia.CONCLUSIONS AND RELEVANCE Among adults with out-of-hospital cardiac arrest, treatment with intravenous or intraosseous calcium compared with saline did not significantly improve sustained return of spontaneous circulation. These results do not support the administration of calcium during out-of-hospital cardiac arrest in adults.

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Section: Discussionmentioning

confidence: 99%

Effect of Intravenous or Intraosseous Calcium vs Saline on Return of Spontaneous Circulation in Adults With Out-of-Hospital Cardiac Arrest

Vallentin

Granfeldt

Meilandt

et al. 2021

JAMA

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“…However this degree of hypocalcemia has not been found to remarkably impair the cardiovascular performance. 1 Literature outlines that supplementing calcium has a positive impact on the postbypass mean arterial pressure and systemic vascular resistance, particularly relevant in context of post-CPB vasoplegia. 1 Several authors also propose a concomitantly increased ventricular cardiac index (CI) with calcium, while some others fail to demonstrate an accentuated CI.…”

Section: To the Editormentioning

confidence: 99%

“…1 Literature outlines that supplementing calcium has a positive impact on the postbypass mean arterial pressure and systemic vascular resistance, particularly relevant in context of post-CPB vasoplegia. 1 Several authors also propose a concomitantly increased ventricular cardiac index (CI) with calcium, while some others fail to demonstrate an accentuated CI. 2 Despite a systolic function augmentation, the negative effects of calcium on diastolic function by causing ventricular stiffness is revealed in literature which raises peculiar concerns in setting of difficult weaning owing to diastolic dysfunction.…”

Section: To the Editormentioning

confidence: 99%

“…2 Despite a systolic function augmentation, the negative effects of calcium on diastolic function by causing ventricular stiffness is revealed in literature which raises peculiar concerns in setting of difficult weaning owing to diastolic dysfunction. 1 With regards to the right ventricle (RV) function, calcium administration is believed to support the RV performance without discernible elevation of pulmonary vascular resistance. 3 The administration of calcium during weaning is compounded by certain important caveats necessitating attention.…”

Section: To the Editormentioning

confidence: 99%

“…First and foremost is the impact of calcium on the myocardium that has suffered an ischemic insult, as calcium overload hypothesis has been centrally implicated in ischemia-reperfusion injury and post-CPB myocardial stunning. 1 The theory of the "calcium-paradox" as supported by the experimental settings, can further affect the myocardial function adversely. 4 The other concern regarding calcium administration in scenario of a pressure-overload hypertrophy emanates from the risk of "stone-heart" syndrome.…”

Section: To the Editormentioning

confidence: 99%

See 2 more Smart Citations

Calcium Administration on Separation from Cardiopulmonary Bypass: Looking Beyond a Facilitated Weaning!

2019

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Hemodynamic Response to Calcium Chloride Boluses in Single-Ventricle Patients with Parallel Circulation

et al. 2021

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Calcium Administration During Weaning From Cardiopulmonary Bypass: A Narrative Literature Review

Cited by 12 publications

References 75 publications

Effect of Intravenous or Intraosseous Calcium vs Saline on Return of Spontaneous Circulation in Adults With Out-of-Hospital Cardiac Arrest

Effect of Intravenous or Intraosseous Calcium vs Saline on Return of Spontaneous Circulation in Adults With Out-of-Hospital Cardiac Arrest

Calcium Administration on Separation from Cardiopulmonary Bypass: Looking Beyond a Facilitated Weaning!

Hemodynamic Response to Calcium Chloride Boluses in Single-Ventricle Patients with Parallel Circulation

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