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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

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Monday, December 6, 2021

Calcium for of out hospital cardiac arrest

First10EM - By Justin Morgenstern - December 6, 2021
“It is not as popular in emergency medicine as magnesium, but there are definitely circles that love calcium and use it liberally in cardiac arrest, while others almost never prescribe it. Calcium is important in cardiac physiology, so it is not hard to formulate a physiologic rationale for its use in cardiac arrest. On the other hand, it is hard to imagine an electrolyte making the difference in a patient without a pulse, and there are a lot of competing priorities when managing a cardiac arrest. Luckily, we no longer have to engage in these theoretical debates; we now have a large RCT (the COCA trial) looking at the question of empiric calcium in out of hospital cardiac arrest. 
The paper
Vallentin MF, Granfeldt A, Meilandt C, et al. 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. 2021 Nov 30. doi: 10.1001/jama.2021.20929. PMID: 34847226
Bottom line
This double blind RCT was stopped early because the data suggests that empiric calcium is harmful in out of hospital cardiac arrest.”