6/28/23, 12:13 AM COCA Pathway Feedback Search Clinical Topics Home Studies COCA COCA Disease Cardiac arrest 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 N = 391 71.0% male 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 27.0 % 27 https://web.pathway.md/studies/reckeOCA4CY2n1LsJ 1/2 6/28/23, 12:13 AM COCA Pathway 20.3 % 19 13.5 % 6.8 % No significant difference 0.0 % Calcium Saline No significant difference in sustained ROSC (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) Borderline 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 ROSC. 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. Open reference URL https://web.pathway.md/studies/reckeOCA4CY2n1LsJ 2/2