• Mikael Fink Vallentin, Asger Granfeldt, Carsten Meilandt, Amalie Ling Povlsen, Birthe Sindberg, Mathias J Holmberg, IversenBo NeesBNPrehospital Emergency Medical Services, Central Denmark Region, Aarhus.Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark., Rikke Mærkedahl, Lone Riis Mortensen, Rasmus Nyboe, Mads Partridge Vandborg, Maren Tarpgaard, Charlotte Runge, Christian Fynbo Christiansen, Thomas H Dissing, Christian Juhl Terkelsen, Steffen Christensen, Hans Kirkegaard, and Lars W Andersen.
• Prehospital Emergency Medical Services, Central Denmark Region, Aarhus.
• JAMA. 2021 Dec 14; 326 (22): 2268-2276.

ImportanceIt is unclear whether administration of calcium has a beneficial effect in patients with cardiac arrest.ObjectiveTo 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 RelevanceAmong 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.Trial RegistrationClinicalTrials.gov Identifier: NCT04153435.

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