(217) Evaluation of Calcium Supplementation During Trauma Resuscitation at a Large Academic Medical Center

Introduction: Trauma is associated with hemorrhage and blood loss, prompting the need for resuscitation and hemostasis. Citrate anticoagulant in blood products chelates physiologic calcium, which is necessary for Vitamin K-dependent clotting factor activation. Literature has shown that hypocalcemia occurs in up to 55% of trauma patients, and is recognized as one of four components of the “lethal diamond” of trauma complications. Guidance regarding calcium supplementation in this area is lacking.

Methods: This was a single-center, retrospective, descriptive study of patients at UAB Hospital who received both blood and calcium products in the emergency department (ED) following Level 1 trauma activation. Patients from 8/1/2022-8/31/2023 were screened for this study. Exclusion criteria were trauma arrest, trauma transfer, pre-hospital blood, pregnancy, incarceration, or age < 18 years. This study aimed to describe calcium supplementation practices during resuscitation in the ED. Data on product selection, dose, and administration timing were collected for both calcium and blood products. Initial trauma lab results were collected, as well as location of blood product and calcium administration.

Results: Fifty patients were analyzed. Patients received higher volumes of blood products in the operating room (OR) than in the ED. Transfusion was balanced with ~1:1 administration of red blood cells to plasma, although a higher proportion of patients in the OR received whole blood than did patients in the ED. Calcium chloride was the most commonly administered calcium salt in both locations, with double the dose in mEq administered in the OR. Most patients had trauma labs collected in the ED, but of the ionized calcium values obtained, only 1 patient (2%) had a result available before leaving the ED. Median initial ionized calcium values were 1.16, and median repeat values were 1.14. Median times (minutes) to blood product administration, calcium administration, and initial/repeat ionized calcium values were 7, 20, 160, and 346 respectively. All 50 patients analyzed received a calcium product before a serum ionized calcium was obtained.

Conclusions: Optimal calcium supplementation during trauma resuscitation in the emergency department remains important, but unexplored. Further studies in this area are needed.