CHSU Discovery

• The American Heart Association (AHA) recommend against the routine use of
calcium during cardiac arrest, except in specific cases where it may be beneficial
(i.e. hyperkalemia, hypocalcemia, calcium channel blocker overdose,
magnesium toxicity).
• Despite these recommendations, calcium is still frequently administered during
cardiac arrest events because it is theorized to improve contractility and
hemodynamic stability.
• However, supra-therapeutic intra-cardiac calcium levels following medication
administration may cause cardiac hypercontraction, impaired contractility, and
reduced cardiac output (“stone heart”).
• The 2025 AHA Guidelines for Cardiopulmonary Resuscitation (CPR) and
Emergency Cardiovascular Care (ECC), released in October 2025, reference
multiple studies indicating that routine calcium administration during cardiac
arrest does not improve survival to hospital discharge or neurological outcomes
and may pose potential harm.

Purpose

• Summarize the studies cited in the 2025 AHA Guidelines for CPR and ECC
evaluating calcium administration during cardiac arrest with a focus on calcium’s
impact on return of spontaneous circulation (ROSC), survival rates, and
neurological outcomes.
• This summary may serve as a consolidated evidence-based reference for
clinicians to refer to.