Calcium in Trauma Resuscitation

Authors

• Patrick Thomas, University of LynchburgFollow

Advisor

Professor Sarah Bolander

Abstract

Trauma remains a leading cause of mortality, particularly in younger populations, with recent literature underscoring the vital yet often overlooked role of calcium in maintaining physiologic stability, especially in the context of severe injury. Hypocalcemia, defined by low serum ionized calcium levels, is strongly associated with worse outcomes, including increased blood product transfusion requirements and higher mortality. This review provides a comprehensive account of calcium's role in trauma resuscitation and summarizes current evidence-based clinical recommendations for its administration. Hypocalcemia is increasingly recognized as the fourth component of the "deadly diamond," alongside the traditional lethal triad of hypothermia, acidosis, and coagulopathy, as calcium is essential for coagulation, myocardial contractility, and vascular tone. Epidemiological data suggest that over half of trauma patients present with hypocalcemia prior to blood transfusion, challenging older protocols focused solely on post-transfusion replacement. The review also clarifies the critical distinction between various calcium measurements and formulations, emphasizing free ionized calcium (fCA) as the clinically relevant metric. While the citrate found in transfused blood products is known to chelate fCA, the high incidence of pre-transfusion hypocalcemia necessitates earlier, more proactive intervention. This article synthesizes updates from leading institutions recommending aggressive calcium replacement, such as administering 1 g of calcium chloride with the first unit of blood product, to improve outcomes. Given that most current supporting literature relies on systematic reviews and meta-analyses of observational data, high-reliability studies, such as randomized controlled trials, are needed to clarify the causal role of hypocalcemia versus its use as a physiological marker.

Recommended Citation

Thomas P. Calcium in Trauma Resuscitation. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2026; 8(1).