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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 Padrao  1 , Brian Bustos  1 , Ashwin Mahesh  1 , Monaliza de Almeida Castro  2 , Ravneet Randhawa  1 , Christopher John Dipollina  1 , Rhanderson Cardoso  3 , Prashant Grover  4 , Bruno Adler Maccagnan Pinheiro Besen  5   6
Affiliations
Review

Calcium use during cardiac arrest: A systematic review

Eduardo Messias Hirano Padrao et al. Resusc Plus. .

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
Fig. 1
Flow diagram of study selection.
Fig. 2
Fig. 2
Randomised Clinical Trials Risk of Bias (RoB2).
Fig. 3
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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