• Gurpreet S Dhillon, Monica E Kleinman, Steven J Staffa, Sarah A Teele, Ravi R Thiagarajan, and American Heart Association’s Get With The Guidelines - Resuscitation (GWTG-R) Investigators.
• Department of Pediatrics, Division of Cardiology, Lucile Packard Children's Hospital at Stanford Medical Center, Stanford, CA.
• Pediatr Crit Care Me. 2022 Nov 1; 23 (11): 860871860-871.

ObjectivesIV calcium administration during cardiopulmonary resuscitation (CPR) for pediatric in-hospital cardiac arrest (IHCA) is associated with worse survival. We evaluated survival to hospital discharge in children with heart disease (HD), where calcium is more frequently administered during CPR.DesignRetrospective study of a multicenter registry database.SettingData reported to the American Heart Association's (AHA) Get With The Guidelines-Resuscitation registry.PatientsChildren younger than 18 years with HD experiencing an index IHCA event requiring CPR between January 2000 and January 2019. Using propensity score matching (PSM), we selected matched cohorts of children receiving and not receiving IV calcium during CPR and compared the primary outcome of survival to hospital discharge.InterventionsNone.Measurements And Main ResultsWe included 4,556 children with HD experiencing IHCA. Calcium was administered in 1,986 (44%), more frequently in children younger than 1 year old (65% vs 35%; p < 0.001) and surgical cardiac (SC) compared with medical cardiac patients (51% vs 36%; p < 0.001). Calcium administration during CPR was associated with longer duration CPR (median 27 min [interquartile range (IQR): 10-50 min] vs 5 min [IQR, 2-16 min]; p < 0.001) and more frequent extracorporeal-CPR deployment (25% vs 8%; p < 0.001). In the PSM cohort, those receiving calcium had decreased survival to hospital discharge (39% vs 46%; p = 0.02) compared with those not receiving calcium. In a subgroup analysis, decreased discharge survival was only seen in SC cohorts.ConclusionsCalcium administration during CPR for children with HD experiencing IHCA is common and is associated with worse survival. Administration of calcium during CPR in children with HD should be restricted to specific indications as recommended by the AHA CPR guidelines.Copyright © 2022 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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