Trial reportThe journal of trauma and acute care surgery2020
Forgot calcium? Admission ionized-calcium in two civilian randomized controlled trials of prehospital plasma for traumatic hemorrhagic shock.
Trial report in The journal of trauma and acute care surgery, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
30 citing papers in PubMed, 2 syntheses or guidelines pooled it, 81 citations in OpenAlex.
- Inhospital coagulation management and fluid replacement therapy in patients with multiple and/or severe injuries - a systematic review and clinical practice guideline update.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025Pooled it
- Hypocalcaemia upon arrival (HUA) in trauma patients who did and did not receive prehospital blood products: a systematic review and meta-analysis.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2024Pooled it
- Early calcium replacement after minimal blood transfusion is associated with adverse outcomes.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026Article
- Pre-Hospital Calcium Administration Reduces Incidence of Hypocalcemia and Mortality in Trauma Patients.Open access emergency medicine : OAEM · 2026Article
- Endothelial Trauma Depends on Surface Charge and Extracellular Calcium Levels.bioRxiv : the preprint server for biology · 2025Article
- [Transfusion of plasma products: an update for anesthesiologists].Die Anaesthesiologie · 2025Article
- Conformational ligand-directed targeting of calcium-dependent receptors in acute trauma.Med (New York, N.Y.) · 2025Article
- Hypocalcemia associated with adverse outcomes following severe traumatic injury in the Western Cape of South Africa: a secondary analysis of multicenter data from the Epidemiology and Outcomes of Prolonged Trauma Care (EpiC) study.International journal of emergency medicine · 2025Article
- Article
- Endothelial Cell Calcium Influx Mediates Trauma-induced Endothelial Permeability.Annals of surgery · 2025Article
- Association between hypocalcemia and mortality in trauma patients: a systematic review and meta-analysis.Trauma surgery & acute care open · 2025Article
- Establishment and validation of a predictive model for lower extremity deep vein thrombosis in patients with traumatic pelvic fractures.Thrombosis journal · 2024Article
- Identification of early coagulation changes associated with survival outcomes post severe burns from multiple perspectives.Scientific reports · 2024Article
- Analysis of risk factors for trauma-induced coagulopathy in elderly major trauma patients.World journal of emergency medicine · 2024Article
- Pre-Hospital Blood Products for the Care of Bleeding Trauma Patients.Deutsches Arzteblatt international · 2023Review
- Articles on hemorrhagic shock published between 2000 and 2021: A CiteSpace-Based bibliometric analysis.Heliyon · 2023Article
- Trauma-induced disturbances in ionized calcium levels correlate parabolically with coagulopathy, transfusion, and mortality: a multicentre cohort analysis from the TraumaRegister DGUCritical care (London, England) · 2023Article
- Perioperative Considerations in Management of the Severely Bleeding Coagulopathic Patient.Anesthesiology · 2023Article
- Hemorrhagic shock and tissue injury provoke distinct components of trauma-induced coagulopathy in a swine model.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2023Article
- How to manage coagulopathies in critically ill patients.Intensive care medicine · 2023Review
Corrections and comments
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Authors and funding
12 authors at 1 institution in 1 country.
Funding
Abstract
backgroundRandomized clinical trials (RCTs) support the use of prehospital plasma in traumatic hemorrhagic shock, especially in long transports. The citrate added to plasma binds with calcium, yet most prehospital trauma protocols have no guidelines for calcium replacement. We reviewed the experience of two recent prehospital plasma RCTs regarding admission ionized-calcium (i-Ca) blood levels and its impact on survival. We hypothesized that prehospital plasma is associated with hypocalcemia, which in turn is associated with lower survival.
methodsWe studied patients enrolled in two institutions participating in prehospital plasma RCTs (control, standard of care; experimental, plasma), with i-Ca collected before calcium supplementation. Adults with traumatic hemorrhagic shock (systolic blood pressure ≤70 mm Hg or 71-90 mm Hg + heart rate ≥108 bpm) were eligible. We use generalized linear mixed models with random intercepts and Cox proportional hazards models with robust standard errors to account for clustered data by institution. Hypocalcemia was defined as i-Ca of 1.0 mmol/L or less.
resultsOf 160 subjects (76% men), 48% received prehospital plasma (median age, 40 years [interquartile range, 28-53 years]) and 71% suffered blunt trauma (median Injury Severity Score [ISS], 22 [interquartile range, 17-34]). Prehospital plasma and control patients were similar regarding age, sex, ISS, blunt mechanism, and brain injury. Prehospital plasma recipients had significantly higher rates of hypocalcemia compared with controls (53% vs. 36%; adjusted relative risk, 1.48; 95% confidence interval [CI], 1.03-2.12; p = 0.03). Severe hypocalcemia was significantly associated with decreased survival (adjusted hazard ratio, 1.07; 95% CI, 1.02-1.13; p = 0.01) and massive transfusion (adjusted relative risk, 2.70; 95% CI, 1.13-6.46; p = 0.03), after adjustment for confounders (randomization group, age, ISS, and shock index).
conclusionPrehospital plasma in civilian trauma is associated with hypocalcemia, which in turn predicts lower survival and massive transfusion. These data underscore the need for explicit calcium supplementation guidelines in prehospital hemotherapy. LEVEL OF EVIDENCE: Therapeutic, level II.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.