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Calcium in cardiac resuscitation

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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.

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