Pre-Hospital Calcium Administration Reduces Incidence of Hypocalcemia and Mortality in Trauma Patients

Background: Extensive literature has established how critical calcium is to countless physiological pathways; however, the consequences of trauma-induced hypocalcemia, if not pro-actively managed, are often overlooked. Data suggests that timely calcium administration may be advantageous in correcting hypocalcemia and preventing unfavorable clinical outcomes. There is limited data examining the impact of pre-hospital calcium administration in trauma patients transported from the injury scene by air ambulance. Our Lifeline air transport service initiated a pre-hospital calcium administration protocol in October 2021. Objective: To determine the efficacy of the pre-hospital calcium protocol on ED ionized calcium (iCa) values and clinical outcomes. Methods: A single-center, retrospective cohort analysis of 87 trauma patients transported from the scene via Lifeline air services was conducted. Cohort 0 had 54 patients who received pre-hospital blood products without calcium, and Cohort 1 had 33 patients who received blood products and calcium. Eleven patients were excluded from final analysis due to missing iCa values. Results: Cohort 1 had significantly higher iCa values (4.92 ± 0.74 vs 4.24 ± 0.76 mg/dL, p -value = 0.007) and lower incidences of hypocalcemia (multivariate OR: 0.03 95% CI: 0.002, 0.27) when compared with Cohort 0. Hospital mortality rates appeared lower in Cohort 1 compared to Cohort 0, though this difference did not reach statistical significance ( p -value = 0.38). Clinical data points including ICU and hospital length of stay were similar. Twelve patients were hypercalcemic on ED arrival: nine in Cohort 1, and three in Cohort 0. This could be attributed to variable injury severities, comorbidities, type and volume of blood products, and calcium overtreatment. Conclusion: The administration of pre-hospital calcium significantly reduced episodes of hypocalcemia and severe hypocalcemia. Keywords: trauma-induced hypocalcemia, hypercalcemia, pre-hospital blood products administration, calcium supplementation, ionized calcium on ED arrival