Calcium during cardiac arrest: A systematic review

Hsu, Cindy H.; Couper, Keith; Nix, Tyler; Drennan, Ian R.; Reynolds, Joshua C.; Kleinman, Monica E.; Berg, Katherine M.

doi:10.1016/j.resplu.2023.100379

Cited by 7 publications

(6 citation statements)

References 28 publications

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“… 117 A SysRev was conducted by members of the ALS Task Force (PROSPERO CRD4202234964). 118 The SysRev included literature on adults and children. The evidence for adults was considered for this CoSTR.…”

Section: Advanced Life Supportmentioning

confidence: 99%

“… 117 , 122 All results are reported in full in the online CoSTR. 119 Calcium has not been studied in the IHCA setting. Therefore, the certainty of evidence for adult IHCA was additionally downgraded for indirectness.…”

Section: Advanced Life Supportmentioning

confidence: 99%

“…The complete evidence-to-decision framework can be found on the ILCOR website, and the evidence-to-decision table is provided in Appendix A. 119 Key points include the following:…”

Section: Advanced Life Supportmentioning

confidence: 99%

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2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces

Berg,

Bray,

et al. 2023

Circulation

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The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.

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Section: Advanced Life Supportmentioning

confidence: 99%

Section: Advanced Life Supportmentioning

confidence: 99%

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2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces

Berg,

Bray,

et al. 2023

Circulation

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“…At present, there is not evidence to support calcium supplementation. Moreover, a recent systematic review of empirical calcium administration for adult patients in cardiac arrest has demonstrated harm [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

The incidence of admission ionised hypocalcaemia in paediatric major trauma—A systematic review and meta-analysis

Hibberd,

Price,

Thomas

et al. 2024

PLoS ONE

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Objectives In adult major trauma patients admission hypocalcaemia occurs in approximately half of cases and is associated with increased mortality. However, data amongst paediatric patients are limited. The objectives of this review were to determine the incidence of admission ionised hypocalcaemia in paediatric major trauma patients and to explore whether hypocalcaemia is associated with adverse outcomes. Methods A systematic review was conducted following PRISMA guidelines. All studies including major trauma patients <18 years old, with an ionised calcium concentration obtained in the Emergency Department (ED) prior to the receipt of blood products in the ED were included. The primary outcome was incidence of ionised hypocalcaemia. Random-effects Sidik-Jonkman modelling was executed for meta-analysis of mortality and pH difference between hypo- and normocalcaemia, Odds ratio (OR) was the reporting metric for mortality. The reporting metric for the continuous variable of pH difference was Glass’ D (a standardized difference). Results are reported with 95% confidence intervals (CIs) and significance was defined as p <0.05. Results Three retrospective cohort studies were included. Admission ionised hypocalcaemia definitions ranged from <1.00 mmol/l to <1.16 mmol/l with an overall incidence of 112/710 (15.8%). For mortality, modelling with low heterogeneity (I2 39%, Cochrane’s Q p = 0.294) identified a non-significant (p = 0.122) estimate of hypocalcaemia increasing mortality (pooled OR 2.26, 95% CI 0.80–6.39). For the pH difference, meta-analysis supported generation of a pooled effect estimate (I2 57%, Cochrane’s Q p = 0.100). The effect estimate of the mean pH difference was not significantly different from null (p = 0.657), with the estimated pH slightly lower in hypocalcaemia (Glass D standardized mean difference -0.08, 95% CI -0.43 to 0.27). Conclusion Admission ionised hypocalcaemia was present in at least one in six paediatric major trauma patients. Ionised hypocalcaemia was not identified to have a statistically significant association with mortality or pH difference.

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“…48 'Calcium-HA' was an SR of intervention benefits that compared the outcomes of routine calcium administration to no calcium administration for cardiac arrest in adults or children. 49 'Infant-NO' was an SR of prognosis that assessed whether an immediate response to inhaled nitric oxide therapy was associated with reduced mortality in preterm infants with hypoxemic respiratory failure and pulmonary hypertension. 50 'Meds-HA' was an SR of SRs, covering intervention benefits, that identified medications that affected hospital admissions.…”

Section: Datasets and Data Acquisitionmentioning

confidence: 99%

Prompting is all you need: LLMs for systematic review screening

Cao,

Sang,

Arora

et al. 2024

Preprint

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Systematic reviews (SRs) are the highest standard of evidence, shaping clinical practice guidelines, policy decisions, and research priorities. However, their labor-intensive nature, including an initial rigorous article screen by at least two investigators, delays access to reliable information synthesis. Here, we demonstrate that large language models (LLMs) with intentional prompting can match human screening performance. We introduce Framework Chain-of-Thought, a novel prompting approach that directs LLMs to systematically reason against predefined frameworks. We evaluated our prompts across ten SRs covering four common types of SR questions (i.e., prevalence, intervention benefits, diagnostic test accuracy, prognosis), achieving a mean accuracy of 93.6% (range: 83.3-99.6%) and sensitivity of 97.5% (89.7-100%) in full-text screening. Compared to experienced reviewers (mean accuracy 92.4% [76.8-97.8%], mean sensitivity 75.1% [44.1-100%]), our full-text prompt demonstrated significantly higher sensitivity in four reviews (p<0.05), significantly higher accuracy in one review (p<0.05), and comparable accuracy in two of five reviews (p>0.05). While traditional human screening for an SR of 7000 articles required 530 hours and $10,000 USD, our approach completed screening in one day for $430 USD. Our results establish that LLMs can perform SR screening with performance matching human experts, setting the foundation for end-to-end automated SRs.

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Calcium during cardiac arrest: A systematic review

Cited by 7 publications

References 28 publications

The incidence of admission ionised hypocalcaemia in paediatric major trauma—A systematic review and meta-analysis

Prompting is all you need: LLMs for systematic review screening

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