Acute cardiac care & resuscitation
Effect of Intravenous or Intraosseous Calcium vs Saline on Return of Spontaneous Circulation in Adults With Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial
- stopped early (planned interim analysis)
- Stopped early by steering committee due to concerns about harm in the calcium group
Authors' conclusion
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.
Study context
- Population
- Adults with OHCA, Central Denmark Region, 2020–2021391 analysed
- Participants
- 397 adults
- Comparison
- IV or intraosseous calcium vs saline during OHCA
- Calciumn = 197
- Salinen = 200reference
- Primary endpoint
- Sustained return of spontaneous circulation
Methodological detailsdouble-blind, placebo-controlled, No loss to follow-up
- Double-blind
- Placebo-controlled
- No loss to follow-up
Primary result
As reported in the abstract
Sustained ROSC
Each group vs salineRR for sustained ROSC (95% CI)P value
Calcium
0.72(0.49–1.03)
P = 0.09Each group vs salineRisk difference for sustained ROSC (95% CI)
Calcium
−7.6%(−16% to 0.8%)
Secondary outcomes
| Outcome | Calcium | Saline | Estimate | P value | |
|---|---|---|---|---|---|
| Survival (alive) · 30 days | 5.2% | 9.1% | RR for being alive 0.57 (95% CI 0.27–1.18) | P = 0.17 | |
| Favorable neurological outcome (mRS 0-3) · 30 days | 3.6% | 7.6% | RR for favorable neurological outcome 0.48 (95% CI 0.20–1.12) | P = 0.12 | |
| 0.20.5125Ratio (log scale) |
| Outcome | Estimate | |
|---|---|---|
| Survival (alive) · 30 days | risk difference for being alive −3.9% (95% CI −9.4% to 1.3%) | |
| Favorable neurological outcome (mRS 0-3) · 30 days | risk difference for favorable neurological outcome −4.0% (95% CI −8.9% to 0.7%) | |
| −10−505Difference (linear scale) |
Safety
Hypercalcemia (patients with ROSC and calcium values measured)
Original publication
Effect of Intravenous or Intraosseous Calcium vs Saline on Return of Spontaneous Circulation in Adults With Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA. Published 14 December 2021. doi:10.
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