Dr. Nutt asks Dr. Vallentin and Andersen viewers' questions about the COCA trial. They discuss the usage, timing, and dosage of calcium in cardiac arrest, as well as the timing of adrenaline administration and the difference between IV and IO administration of calcium.
The COCA trial results indicate that calcium should no longer be used in cardiac arrest due to potential harm and differences in observed rhythms.
The COCA trial administered calcium early in resuscitation based on European guidelines and ALS algorithm recommendations, but did not test the effect of slow administration.
Deep dives
Decision to Stop Using Calcium in Cardiac Arrest
In this podcast episode, the speaker discusses the decision to stop using calcium in cardiac arrest. The general consensus is that calcium should no longer be used in cardiac arrest due to the findings of the study. The data showed a low event rate and differences in the types of rhythms observed between the calcium and non-calcium groups. Although the adjusted analysis attenuated the results, there was still a signal towards harm. The decision not to have predefined stopping criteria was deliberate, allowing examination of secondary outcomes and adverse events.
Dose Selection and Timing of Calcium Administration
The podcast also covers the selection of the calcium dose and the timing of its administration. The chosen dose was based on European guidelines and standard practice in Denmark. It was administered early in resuscitation to potentially see an effect. The timing of administration differed between shockable and non-shockable rhythms, following ALS algorithm recommendations. The speed of administration and the suggestion of slower administration to avoid potential side effects were also discussed. However, the trial did not test the effect of slow administration.
Different Routes of Calcium Administration and Timing
The discussion also touched upon the different routes of calcium administration and their timing. The trial did not specifically compare ionized calcium levels between intravenous (IV) and intraosseous (IO) administration. However, a higher proportion of patients received calcium via IO, including first-line access. Despite the route of administration, there was no significant difference in return of spontaneous circulation, survival, or neurological outcome. The podcast episode concludes by suggesting that administering drugs earlier in cardiac arrests is challenging but may be possible in innovative ways.
Dr Chris Nutt asks Dr Mikael Fink Vallentin and Lars Andersen questions form the viewers, during the livestream presentation of the COCA trial results. The COCA trial investigates calcium for out-of-hospital cardiac arrest and was presented at a Critical Care Reviews Trial Results Presentation Livestream on November 30th, 2021, with a simultaneous publication in JAMA.
Get the Snipd podcast app
Unlock the knowledge in podcasts with the podcast player of the future.
AI-powered podcast player
Listen to all your favourite podcasts with AI-powered features
Discover highlights
Listen to the best highlights from the podcasts you love and dive into the full episode
Save any moment
Hear something you like? Tap your headphones to save it with AI-generated key takeaways
Share & Export
Send highlights to Twitter, WhatsApp or export them to Notion, Readwise & more
AI-powered podcast player
Listen to all your favourite podcasts with AI-powered features
Discover highlights
Listen to the best highlights from the podcasts you love and dive into the full episode