Calcium use during cardiac arrest: A systematic review

Padrão, Eduardo Messias Hirano; Bustos, Brian; Mahesh, Ashwin; Castro, Monaliza de Almeida; Randhawa, Ravneet; Dipollina, Christopher John; Cardoso, Rhanderson; Grover, Prashant; Besen, Bruno Adler Maccagnan Pinheiro

doi:10.1016/j.resplu.2022.100315

Cited by 5 publications

(3 citation statements)

References 30 publications

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“…Calcium administration in case of hyperkalaemia-induced electrocardiogram abnormalities to stabilize the myocellular membrane is common practise, yet no RCT has shown its efficacy to date [43]. On the basis of the rationale that calcium enhances electrical defibrillation and myocardial contractility, routine calcium administration used to be recommended in case of cardiac arrest until two RCTs published in the 80 s showed no benefit of calcium in pulseless electrical activity arrests [44 ▪ ]. Nevertheless, a significant increase in calcium administration during adult in-hospital cardiac arrest in the United States between 2001 and 2016 was observed, possibly due to unchanged recommendations concerning the routine use of calcium [45].…”

Section: Management Of Hypocalcaemia In the Icumentioning

confidence: 99%

“…Nevertheless, a significant increase in calcium administration during adult in-hospital cardiac arrest in the United States between 2001 and 2016 was observed, possibly due to unchanged recommendations concerning the routine use of calcium [45]. Recently, results of an RCT including 397 adults in Denmark showed no beneficial effects of calcium administration on the return of spontaneous circulation in patients with out-of-hospital cardiac arrest [44 ▪ ,46 ▪▪ ]. The trial was early terminated because fewer patients who received calcium had a favourable neurological outcome and quality of life at 90 days [46 ▪▪ ].…”

Section: Management Of Hypocalcaemia In the Icumentioning

confidence: 99%

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Management of hypocalcaemia in the critically ill

Melchers

Zanten

2023

Current Opinion in Critical Care

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Purpose of review To better understand the established associations between hypocalcaemia and clinical outcomes, we synopsize the mechanisms involved in hypocalcaemia in the critically ill. We also provide an overview of the current evidence on managing hypocalcaemia in critical illness. Recent findings Hypocalcaemia is reported to occur in 55–85% of ICU patients. It appears to be associated with poor outcomes. It appears to be associated with poor outcomes, but it may be a marker rather than a direct cause of disease severity. The recommendations to correct calcium in major bleeding are found on weak evidence and require further exploration by a randomized controlled trial (RCT). Calcium administration in cardiac arrest has shown no benefit and may provoke harm. In addition, no RCT has assessed the risks and benefits of calcium supplementation in critically ill hypocalcemic patients. Several recent studies conclude that it may even harm septic ICU patients. These observations are supported by evidence that septic patients using calcium channel blockers may have better outcomes. Summary Hypocalcaemia is common in critically ill patients. Direct evidence that calcium supplementation improves their outcomes is lacking, and there is even some indication that it may be detrimental. Prospective studies are required to elucidate the risks and benefits, and the pathophysiological mechanisms involved.

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Section: Management Of Hypocalcaemia In the Icumentioning

confidence: 99%

Section: Management Of Hypocalcaemia In the Icumentioning

confidence: 99%

Management of hypocalcaemia in the critically ill

Melchers

Zanten

2023

Current Opinion in Critical Care

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“…After one year, 3.6% of patients were alive with a favorable neurological outcome in the calcium group vs. 8.6% in the saline group (Relative Risk (RR): 0.42; 95% CI: 0.18–0.97) [ 122 ]. A systematic review published in December 2022 including 3 RCTs showed no benefit with calcium administration and possible harm with unfavorable neurologic outcome at 90 days [ 123 ]. The possible mechanism behind this finding may be that the anaerobic state of CPR triggers an influx of calcium by the Na/Ca exchanger [ 124 ].…”

Section: Other Cardiac Arrest Drugsmentioning

confidence: 99%

A Narrative Review of Drug Therapy in Adult and Pediatric Cardiac Arrest

Jaeger¹,

Márquez²,

Kosmopoulos³

et al. 2023

Rev. Cardiovasc. Med.

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Drugs are used during cardiopulmonary resuscitation (CPR) in association with chest compressions and ventilation. The main purpose of drugs during resuscitation is either to improve coronary perfusion pressure and myocardial perfusion in order to achieve return of spontaneous circulation (ROSC). The aim of this up-to-date review is to provide an overview of the main drugs used during cardiac arrest (CA), highlighting their historical context, pharmacology, and the data to support them. Epinephrine remains the only recommended vasopressor. Regardless of the controversy about optimal dosage and interval between doses in recent papers, epinephrine should be administered as early as possible to be the most effective in non-shockable rhythms. Despite inconsistent survival outcomes, amiodarone and lidocaine are the only two recommended antiarrhythmics to treat shockable rhythms after defibrillation. Beta-blockers have also been recently evaluated as antiarrhythmic drugs and show promising results but further evaluation is needed. Calcium, sodium bicarbonate, and magnesium are still widely used during resuscitation but have shown no benefit. Available data may even suggest a harmful effect and they are no longer recommended during routine CPR. In experimental studies, sodium nitroprusside showed an increase in survival and favorable neurological outcome when combined with enhanced CPR, but as of today, no clinical data is available. Finally, we review drug administration in pediatric CA. Epinephrine is recommended in pediatric CA and, although they have not shown any improvement in survival or neurological outcome, antiarrhythmic drugs have a 2b recommendation in the current guidelines for shockable rhythms.

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