Thompson B M, Steuven H S, Tonsfeldt D J, Aprahamian C, Troiano P F, Kastenson G H, Hendley G E, Mateer J R, Tucker J F
Circulation. 1986 Dec;74(6 Pt 2):IV90-3.
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.
自20世纪20年代以来，氯化钙就被推荐用于心脏停搏、电机械分离（EMD）和心室颤动的复苏治疗。关于其副作用和并发症的报道众多。按照美国心脏协会推荐剂量进行钙检测的研究表明，血清水平会危险地升高。在密尔沃基和坦帕进行的大型回顾性临床研究发现，没有证据表明氯化钙能提高心脏停搏和电机械分离患者的生存率。在密尔沃基护理急救系统中，采用美国心脏协会标准方案，对心脏停搏和电机械分离患者进行的一项前瞻性随机双盲研究，比较了氯化钙组和生理盐水对照组，结果显示，对于心脏停搏节律，钙治疗组和非钙治疗组在复苏率或长期生存率方面没有统计学上的显著差异。虽然给予氯化钙时，电机械分离患者的复苏率在统计学上有所提高，但只有一名患者存活至出院。由于心脏停搏和电机械分离患者的复苏率和长期生存率较低，要证明氯化钙不能提高生存率需要进行大型多中心试验。然而，由于没有对照研究记录到显著益处，因此不支持在心脏停搏和电机械分离中常规使用氯化钙。长期以来，钙一直用于治疗低钙血症和高钾血症，对于有适当临床病史和低钙血症临床体征的濒死患者，应给予钙剂治疗。
