COCA
Trial question
What is the effect of intravenous or intraosseous administration of calcium in adults with out-of-hospital cardiac arrest?
Study design
Multi-center
Double blinded
RCT
Population
Characteristics of study participants
29.0% female
71.0% male
N = 391
391 patients (114 female, 277 male).
Inclusion criteria: adult patients with out-of-hospital cardiac arrest who received at least 1 dose of epinephrine during the cardiac arrest.
Key exclusion criteria: traumatic cardiac arrest, pregnancy, prior enrollment in the trial, receipt of epinephrine outside the trial, or clinical indication for calcium.
Interventions
N=193 calcium (up to 2 doses of intravenous or intraosseous calcium chloride, 5 mmol).
N=198 saline (up to 2 doses of intravenous or intraosseous 9 mg/mL sodium chloride).
Primary outcome
Sustained return of spontaneous circulation
19%
27%
27.0 %
20.3 %
13.5 %
6.8 %
0.0 %
Calcium
Saline
No significant
difference ↔
No significant difference in sustained return of spontaneous circulation (19% vs. 27%; RR 0.72, 95% CI 0.49 to 1.03).
Secondary outcomes
No significant difference in survival at day 30 (5.2% vs. 9.1%; RR 0.57, 95% CI 0.27 to 1.18).
No significant difference in favorable neurological outcome at day 30 (3.6% vs. 7.6%; RR 0.48, 95% CI 0.2 to 1.12).
Significant decrease in favorable neurological outcome at day 90 (3.6% vs. 9.1%; RR 0.4, 95% CI 0.17 to 0.91).
Conclusion
In adult patients with out-of-hospital cardiac arrest who received at least 1 dose of epinephrine during the cardiac arrest, calcium was not superior to saline with respect to sustained return of spontaneous circulation.
Reference
Mikael Fink Vallentin, Asger Granfeldt, Carsten Meilandt 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 Dec 14;326(22):2268-2276.
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