COCA
Calcium for Out-of-hospital Cardiac Arrest
Paziente / Popolazione Intervento / Esposizione Confronto Esito
In 391 adults with out-of-hospital cardiac arrest receiving epinephrine, calcium chloride did not improve sustained return of spontaneous circulation compared with saline placebo.
N
391
Disegno
Double-blind, placebo-controlled randomised clinical trial in the Central Denmark Region (Jan 2020–Apr 2021); 397 adults with non-traumatic out-of-hospital cardiac arrest receiving epinephrine were randomised to up to two intravenous or intraosseous doses of 5 mmol calcium chloride (n=197) or saline (n=200), the first given immediately after the first dose of epinephrine; 1221 arrests were screened, mean age 68 years, 71% male, 82% arrest at home, 85% bystander CPR, 51% asystole, median time from arrest to trial drug 18 minutes (IQR 14–23); stopped early by the steering committee after a planned interim analysis of 383 patients because of a harm signal.
Esito
Primary: sustained return of spontaneous circulation (no further chest compressions for ≥20 minutes). Secondary: survival and survival with a favourable neurological outcome (modified Rankin Scale 0–3) at 30 and 90 days; health-related quality of life at 90 days.
RisultatoSustained ROSC occurred in 37/193 (19%) with calcium vs 53/198 (27%) with saline (RR 0.72, 95% CI 0.49–1.03; risk difference −7.6%; P=.09). At 30 days, survival was 5.2% vs 9.1% (RR 0.57, 95% CI 0.27–1.18) and favourable neurological outcome 3.6% vs 7.6% (RR 0.48, 95% CI 0.20–1.12). At 90 days, survival with a favourable neurological outcome was 3.6% (7/193) vs 9.1% (18/198), RR 0.40 (95% CI 0.17–0.91), favouring saline. Health-related quality of life at 90 days in survivors also favoured saline, not calcium. Hypercalcaemia was present in 26/35 (74%) of calcium-group patients with measured values after ROSC vs 1 (2%) with saline.
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;326(22):2268-2276. 10.1001/jama.2021.20929