• Mikael Fink Vallentin, Asger Granfeldt, Carsten Meilandt, Amalie Ling Povlsen, Birthe Sindberg, Mathias J Holmberg, IversenBo NeesBNPrehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark; 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, Denmark.
• Resuscitation. 2022 Oct 1; 179: 21-24.

ObjectiveThe Calcium for Out-of-hospital Cardiac Arrest (COCA) trial was a randomized, placebo-controlled, double-blind trial of calcium for out-of-hospital cardiac arrest. The primary and secondary outcomes have been reported previously. This article describes the long-term outcomes of the trial.MethodsPatients aged ≥18 years were included if they had a non-traumatic out-of-hospital cardiac arrest during which they received adrenaline. The trial drug consisted of calcium chloride (5 mmol) or saline placebo given after the first dose of adrenaline and again after the second dose of adrenaline for a maximum of two doses. This article presents pre-specified analyses of 6-month and 1-year outcomes for survival, survival with a favorable neurological outcome (modified Rankin Scale of 3 or less), and health-related quality of life.ResultsA total of 391 patients were analyzed. At 1 year, 9 patients (4.7%) were alive in the calcium group while 18 (9.1%) were alive in the placebo group (risk ratio 0.51; 95% confidence interval 0.24, 1.09). At 1 year, 7 patients (3.6%) were alive with a favorable neurological outcome in the calcium group while 17 (8.6%) were alive with a favorable neurological outcome in the placebo group (risk ratio 0.42; 95% confidence interval 0.18, 0.97). Outcomes for health-related quality of life likewise suggested harm of calcium but results were imprecise with wide confidence intervals.ConclusionsEffect estimates remained constant over time suggesting harm of calcium but with wide confidence intervals. The results do not support calcium administration during out-of-hospital cardiac arrest.Trial RegistrationClinicalTrials.gov-number, NCT04153435.Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.

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