Calcium in cardiac resuscitation

Trials show no benefit of calcium administration in cardiac resuscitation. Theoretically, it should improve excitation-contraction coupling and increase automaticity, but calcium causes cell death and ischaemia.

Calcium is indicated during resuscitation from pulseless electrical activity if this is thought to be caused by:

• hyperkalaemia
• hypocalcaemia
• overdose of calcium-channel-blocking drugs
• overdose of magnesium (e.g. during treatment of pre-eclampsia)

In adults, the initial dose of 10 ml 10% calcium chloride (6.8 mmol Ca2+) may be repeated if necessary

Notes:

• calcium can slow the heart rate and precipitate arrhythmias
• in cardiac arrest, calcium may be given by rapid intravenous injection. In the presence of a spontaneous circulation it should be given slowly
• do not give calcium solutions and sodium bicarbonate simultaneously by the same venous access.

Reference:

1. Resuscitation Council (UK). Adult Advanced Life Support. Resuscitation Guidelines 2005.