Clinical and hemodynamic effect of intravenous calcium administration in cardiac surgery: A systematic review.

BACKGROUND

Intravenous calcium is frequently administered in cardiac surgery patients to improve hemodynamics.

OBJECTIVES

To assess safety and efficacy of intravenous calcium administration in this population.

METHODS

We conducted a systematic review (with meta-analysis of hemodynamic data) and searched PubMed and Scopus up to March 15th, 2025. All studies investigating intravenous calcium administration in patients undergoing cardiac surgery were considered. Animal studies and studies investigating oral calcium administration were excluded. We abstracted data on study design, sample size, setting, calcium formulation, dose and timing of administration. Primary outcome was all-cause mortality. Secondary outcomes included rate of myocardial ischemia, postoperative release of cardiac necrosis biomarkers, adverse events, and hemodynamic data. Only data from randomized controlled trials (RCTs) were included in the quantitative analysis.

RESULTS

Twenty-two studies were selected (nine RCTs, eight pediatric studies, ten including a control group), with a total sample size of 1278 patients (809 receiving calcium). The most common formulation was calcium chloride. Most studies followed up patients for <60 min. Only one non-RCT study with a control group reported mortality data (4/66 [6.1 %] calcium group vs 8/69 [11.6 %] control group). Intravenous calcium transiently increases mean arterial pressure (MAP) and reduces heart rate, with effects fading within 10-20 min. Calcium administration may blunt hemodynamic response to catecholamines

CONCLUSIONS

There is no data on the effects of intravenous calcium on major clinical outcomes in patients undergoing cardiac surgery. Calcium may transiently improve MAP and reduce heart rate. Large RCTs are needed to assess the effects of calcium on clinically relevant endpoints.

REVIEW REGISTRATION: International Prospective Register of Systematic Reviews (PROSPERO), n. CRD420250282624.