Calcium Administration During Weaning From Cardiopulmonary Bypass: A Narrative Literature Review

Vladimir V. Lomivorotov, Elizaveta A. Leonova, Alessandro Belletti, Vladimir A. Shmyrev, Giovanni Landoni

Research output: Contribution to journalReview articlepeer-review


The search for safe and effective patient management strategies during weaning from cardiopulmonary bypass is ongoing; intravenous calcium is occasionally used as a first-line drug. The physiologic role of calcium suggests that it can support the function of the cardiovascular system during this critical period. Patients may be mildly hypocalcemic after cardiopulmonary bypass; however, this degree of hypocalcemia does not significantly impair the cardiovascular system. The transient beneficial effects of calcium administration (increase in arterial blood pressure, systemic vascular resistance, cardiac index, stroke volume, and coronary perfusion pressure) might be helpful in cases of moderate contractility reduction or vasoplegia. Nonetheless, effects on clinically relevant endpoints are unknown, and possible systemic side effects, such as transient reduction in internal mammary artery graft flow, attenuation of the effects of β-sympathomimetics, “stone heart” phenomenon, and pancreatic cellular injury, may limit the use of calcium salts. Further studies are needed to expand the understanding of the effects of calcium administration on patient outcomes.

Original languageEnglish
Pages (from-to)235-244
Number of pages10
JournalJournal of Cardiothoracic and Vascular Anesthesia
Issue number1
Publication statusPublished - Jan 2020


  • calcium
  • hypocalcemia
  • inotropes
  • vasopressors
  • weaning from cardiopulmonary bypass

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine


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