From the Guidelines
Calcium chloride is not routinely recommended in metabolic acidosis cardiac arrest, and its use should be limited to specific situations such as hyperkalemia, hypocalcemia, calcium channel blocker overdose, or magnesium toxicity. The most recent and highest quality study, published in 2023 1, suggests that the effect of calcium administration remains unknown for adults in cardiac arrest from special circumstances, and existing trials provide insufficient data on these subgroups to be able to evaluate this.
Key Considerations
- The typical dose of calcium chloride is 10% calcium chloride 10-20 mL (1-2 grams) administered intravenously over 5-10 minutes with cardiac monitoring, but it can be given as a more rapid push in cardiac arrest situations.
- Calcium chloride is preferred over calcium gluconate in emergency situations due to its higher elemental calcium content (27% vs 9%).
- The rationale against routine use of calcium chloride is that metabolic acidosis in cardiac arrest is primarily due to tissue hypoperfusion and anaerobic metabolism, which is best addressed by high-quality CPR, appropriate ventilation, and treating the underlying cause.
Clinical Implications
- Calcium administration does not correct metabolic acidosis and may potentially worsen outcomes by increasing intracellular calcium in ischemic myocardium, which can lead to cell death.
- Focus should remain on standard ACLS protocols including epinephrine, defibrillation for shockable rhythms, and addressing reversible causes, as recommended by the 2023 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations 1.
- The 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care also suggest that calcium may be considered when hyperkalemia or hypermagnesemia is suspected as the cause of cardiac arrest, but this is based on lower quality evidence 1.
From the Research
Calcium Chloride in Metabolic Acidosis Cardiac Arrest
- There is no direct evidence in the provided studies regarding the use of calcium chloride in metabolic acidosis cardiac arrest.
- However, the studies discuss the management of metabolic acidosis in cardiac arrest, which may be relevant to the use of calcium chloride.
- Metabolic acidosis in cardiac arrest is a complex condition that involves multiple factors, including hyperlactatemia, strong ion gap, and phosphate 2.
- The use of buffer agents, such as sodium bicarbonate, is controversial and has not been proven to improve outcomes in cardiac arrest 3, 4, 5.
- The management of metabolic disturbances in cardiac arrest is largely based on supportive care, including adequate ventilation, effective chest compressions, and correction of electrolyte imbalances 3, 6.
- Calcium chloride may be used to correct hypocalcemia, which can occur in cardiac arrest, but its use in metabolic acidosis is not specifically addressed in the provided studies.
- Further research is needed to determine the optimal management of metabolic acidosis in cardiac arrest, including the potential role of calcium chloride 4, 6.