丹麦奥胡斯大学医院Lars W. Andersen团队比较了静脉或骨内钙vs生理盐水对院外心脏骤停成人自主循环恢复的影响。该研究成果发表在2021年11月30日出版的《美国医学会杂志》上。

目前尚不清楚钙剂是否对心脏骤停患者有益。为了确定在院外心脏骤停期间补充钙是否能改善成人自主循环的恢复，2020年1月20日至2021年4月15日，研究组在丹麦中部地区进行了一项双盲、安慰剂对照、随机临床试验，招募了397名院外心脏骤停的成人患者，最后90天随访至2021年7月15日。

将参与者随机分组，197例接受最多2次静脉或骨内输注5 mmol剂量的氯化钙，200例接受生理盐水，均在第一剂肾上腺素后立即给药。主要结局是自主循环的持续恢复。次要结局包括30天和90天的生存率和良好神经预后（改良Rankin评分为0-3分）。

根据计划对383名患者进行了中期分析，由于担心钙组的危害，试验提前停止。在随机分组的397名成年患者中，391名被纳入分析（钙组193名，生理盐水组198名；平均年龄68岁；29%为女性）。后续随访无失访者。

钙组有37名患者（19%）持续恢复自主循环，而盐水组有53名（27%），风险比为0.72。30天时，钙组有10名患者（5.2%）仍存活，生理盐水组有18名（9.1%），风险比为0.57。

钙组有7名患者（3.6%）在30天时观察到良好的神经功能结局，生理盐水组有15名（7.6%），风险比为0.48。在测量钙值并恢复自主循环的患者中，钙组中有26例（74%）出现高钙血症，盐水组有1例（2%）。

研究结果表明，对于院外心脏骤停的成年人，与生理盐水相比，静脉或骨内钙治疗并没有显著改善自主循环的持续恢复。该结果不支持在成人院外心脏骤停期间补充钙。

附：英文原文

Title: 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

Author: Mikael Fink Vallentin, Asger Granfeldt, Carsten Meilandt, Amalie Ling Povlsen, Birthe Sindberg, Mathias J. Holmberg, Bo Nees Iversen, Rikke Mrkedahl, Lone Riis Mortensen, Rasmus Nyboe, Mads Partridge Vandborg, Maren Tarpgaard, Charlotte Runge, Christian Fynbo Christiansen, Thomas H. Dissing, Christian Juhl Terkelsen, Steffen Christensen, Hans Kirkegaard, Lars W. Andersen

Issue&Volume: 2021-11-30

Abstract:

Importance  It is unclear whether administration of calcium has a beneficial effect in patients with cardiac arrest.

Objective  To determine whether administration of calcium during out-of-hospital cardiac arrest improves return of spontaneous circulation in adults.

Design, Setting, and Participants  This double-blind, placebo-controlled randomized clinical trial included 397 adult patients with out-of-hospital cardiac arrest and was conducted in the Central Denmark Region between January 20, 2020, and April 15, 2021. The last 90-day follow-up was on July 15, 2021.

Interventions  The intervention consisted of up to 2 intravenous or intraosseous doses with 5 mmol of calcium chloride (n=197) or saline (n=200). The first dose was administered immediately after the first dose of epinephrine.

Main Outcomes and Measures  The primary outcome was sustained return of spontaneous circulation. The secondary outcomes included survival and a favorable neurological outcome (modified Rankin Scale score of 0-3) at 30 days and 90 days.

Results  Based on a planned interim analysis of 383 patients, the steering committee stopped the trial early due to concerns about harm in the calcium group. Of 397 adult patients randomized, 391 were included in the analyses (193 in the calcium group and 198 in the saline group; mean age, 68 [SD, 14] years; 114 [29%] were female). There was no loss to follow-up. There were 37 patients (19%) in the calcium group who had sustained return of spontaneous circulation compared with 53 patients (27%) in the saline group (risk ratio, 0.72 [95% CI, 0.49 to 1.03]; risk difference, 7.6% [95% CI, 16% to 0.8%]; P=.09). At 30 days, 10 patients (5.2%) in the calcium group and 18 patients (9.1%) in the saline group were alive (risk ratio, 0.57 [95% CI, 0.27 to 1.18]; risk difference, 3.9% [95% CI, 9.4% to 1.3%]; P=.17). A favorable neurological outcome at 30 days was observed in 7 patients (3.6%) in the calcium group and in 15 patients (7.6%) in the saline group (risk ratio, 0.48 [95% CI, 0.20 to 1.12]; risk difference, 4.0% [95% CI, 8.9% to 0.7%]; P=.12). Among the patients with calcium values measured who had return of spontaneous circulation, 26 (74%) in the calcium group and 1 (2%) in the saline group had hypercalcemia.

Conclusions and Relevance  Among adults with out-of-hospital cardiac arrest, treatment with intravenous or intraosseous calcium compared with saline did not significantly improve sustained return of spontaneous circulation. These results do not support the administration of calcium during out-of-hospital cardiac arrest in adults.

DOI: 10.1001/jama.2021.20929

Source: https://jamanetwork.com/journals/jama/fullarticle/2786819