Aggressive calcium chloride dosing reduces early mortality in trauma patients receiving whole blood resuscitation

BACKGROUND: – Hypocalcemia has been recognized as. contributor to trauma-related mortality, yet optimal dosing of calcium during massive transfusion remains undefined. The literature suggests that ≥1 g of calcium per. to. units of blood may correct hypocalcemia, but its effect on survival is unclear. This study evaluated the association between varying calcium:low-titer. whole blood (LTOWB) ratios and 24-hour mortality to define clinically meaningful supplementation targets. METHODS: – We performed. retrospective single-center cohort study of all trauma patients receiving LTOWB and calcium, prehospital, or within. hours of arrival (2020–2023). Demographics, mechanism of injury, Injury Severity Score (ISS), transfusion volume, and calcium administration were collected. Calcium supplementation was defined as. continuous variable (grams/unit), mutually exclusive ranges, and threshold doses of ≥1 g per 2, 3, or. units of LTOWB. The primary outcome was 24-hour mortality. Multivariable logistic regression adjusted for confounders and calcium supplementation strategy. RESULTS: – Of 542 LTOWB recipients, 99 undergoing CPR were excluded; 164 received no calcium, and 273 had complete datasets for analysis. Median age was 36 (25–50) years, 72% were male, median ISS was 19 [10–28], and 55% sustained blunt trauma. Median arrival ionized calcium was 1.02 (0.79–1.14) mEq/L. Twenty-four-hour mortality was 13.6% (n=37). On multivariable analysis, ≥1 g calcium chloride per. units of LTOWB independently reduced the odds of 24-hour mortality by 84% [odds ratio, 0.164 (0.034–0.796), p=0.025]. Calcium chloride at this threshold neared significance for reduction in mortality (p=0.06, adjusted OR=0.221 (0.045–1.077)] when restricting the analysis to patients receiving ≥2 units of LTOWB, while gluconate had no significant associations in this cohort with greater need for LTOWB resuscitation. CONCLUSIONS: – In trauma patients receiving LTOWB, calcium chloride administered at ≥1 g per. units showed. consistent association with improved early survival.. ≥1:2 calcium chloride-to-LTOWB dosing protocol may be an effective and clinically relevant target for trauma resuscitation. Prospective validation is warranted. (J Trauma Acute Care Surg. 2026;00: 00–00.