Calcium chloride has been advocated since the 1920s for the
resuscitation of
asystole, electromechanical dissociation (EMD), and
ventricular fibrillation. Reports of side effects and complications have been numerous. Studies of
calcium assays following American Heart Association recommended dosages have shown dangerously elevated serum levels. Large retrospective clinical studies in Milwaukee and Tampa have found no evidence of improved survival with
calcium chloride in
asystole and EMD. A prospective randomized double-blind study comparing
calcium chloride and saline controls in the Milwaukee Paramedic system for
asystole and EMD using standard AHA protocols showed no statistically significant difference in
resuscitation rates or long-term survival between the
calcium and no-
calcium groups for the rhythm of
asystole. Although patients with EMD had statistically improved
resuscitation rates when
calcium chloride was given, only one of the patients survived to hospital discharge. Because of the low rates of
resuscitation and long-term survival in patients presenting in
asystole and EMD, proving that
calcium chloride does not enhance survival would require large multicenter trials. However, since no controlled study has ever documented significant benefit, its routine use in
asystole and EMD cannot be supported.
Calcium has long been used in medical treatment of hypocalcemic and hyperkalemic states and should be administered in moribund patients who have the proper clinical history and clinical signs of
hypocalcemia.