Cardiac arrest: calcium chloride increased success of resuscitation.

Clinical bottom line (level 1b-)

  1. Patients with electromechanical dissociation who were given calcium chloride, may be more likely to have a successful resuscitation compared with those given saline, but there was no clear difference.
Stueven et al: Annals of Emergency Medicine 1985; 14: 626-629
Expires October 2003

The study

Double-blinded ?concealed randomised trial with intention-to-treat
Setting: 1 community, USA (a two-tiered prehospital system)

90 patients (aged range 22 to 93 years; mean 69, 57% male) electromechanical dissociation (any electrical complex without pulses to exclude ventricular fibrillation and ventricular tachycardia) at the time of entry to study

Excluded if
  • protocol not followed
  • patient received intravenous calcium chloride at any time
  • presented with trauma
  • presented with poisoning
  • paediatric arrest


    • Control Group: (n = 42, 42 analysed): 5 mL saline
    Experimental Group: (n = 48, 48 analysed): 5 mL 10% solution of calcium chloride (500 mg)

    100% followed for ?
    Outcome notes:
    • successful resuscitation : conveyance of a patient with a pulse to an emergency department

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    successful resuscitation unknown 2
    (4.76%)    		 8
    (16.7%)    		 13%
    (-1% to 24%)    		 11.9%
    (-0.45% to 24.26%)    		 8
    (NNT = 4 to infinity;
    NNH = 222 to infinity)

    Comments

    1. The study is too small to show any clear difference in successful resuscitation between the two groups.
    2. Advanced Cardiac Life Support protocols were followed.

    Citation

    1. Stueven HA, Thompson B, Aprahamian C, et al: The effectiveness of calcium chloride in refractory electromechanical dissociation. Annals of Emergency Medicine 1985; 14: 626-629
    Contributor: Clare Wotton and Musab Hayatli, October 1999
    Reviewer:

    Clinical Question.
    Patient electromechanical dissociation
    Intervention or Exposure calcium chloride
    Comparison saline
    Outcome successful resuscitation