Cardiac arrest: asystole: there was no clear benefit from calcium chloride

Clinical bottom line (level 1b-)

  1. Patients who had a cardiac arrest and remained in refractory asystole were not clearly more likely to survive if they received calcium chloride compared with placebo.
Steuven et al: Annals of Emergency Medicine 1985; 14 (7): 630-632
Expires October 2003

The study

Double-blinded ?concealed randomised trial with intention-to-treat
Setting: county, USA

73 patients (aged mean 65, 71% male) in asystole refractory to CPR, oxygen, epinephrine, bicarbonate, and atropine 1 mg iv

Excluded if
  • poisoning
  • trauma
  • children
  • paramedics unable to obtain IV access or intubate


    • Note:
  • Patients who were not resuscitated then received isoproterenol.


    • Control Group: (n = 34, 34 analysed): placebo
    Experimental Group: (n = 39, 39 analysed): calcium chloride 500 mg in 5 ml iv

    100% followed for 60 minutes
    Outcome notes:
    • successful resuscitation : conveyance of patient with a pulse and rhythm to an emergency department

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    successful resuscitation 60 minutes 1
    (2.94%)    		 3
    (7.69%)    		 162%
    (-71% to 2300%)    		 4.75%
    (-5.36% to 14.9%)    		 21
    (NNT = 7 to infinity;
    NNH = 19 to infinity)

    Comments

    1. No patient survived to discharge.
    2. Emergency medical technicians performed CPR using Advanced Life Support protocols
    3. The study is not large enough to show any benefit from using calcium chloride.

    Citation

    1. Steuven HA, Thompson B, Aprahamian C, et al: Lack of effectiveness of calcium chloride in refractory asystole. Annals of Emergency Medicine 1985; 14 (7): 630-632
    Search Terms: resuscitat* in Cochrane
    Contributor: Chris Ball and Clare Wotton, October 1999
    Reviewer:

    Clinical Question.
    Patient cardiac arrest
    Intervention or Exposure calcium chloride
    Outcome mortality, survival