Thrombotic Complications Associated With Right Atrial Lines in Neonates and Infants Undergoing Cardiac Surgery. Is Calcium Chloride a Culprit?

Objectives: To determine if a change from calcium chloride to calcium gluconate infusion resulted in a decreased incidence of atrial thrombi and thrombotic events in neonates undergoing cardiac surgery. Design: A single-center, retrospective cohort analysis. Setting: A single center in Houston, TX. Participants: 135 neonates undergoing cardiac surgery who had either a central venous catheter or tunneled atrial catheter placed and received infusions of either calcium chloride or calcium gluconate in the perioperative period. Interventions: Patients either received a calcium chloride or calcium gluconate infusion in the perioperative period. Measurements and Main Results: The study cohort consisted of 93 procedures using calcium chloride and 88 procedures using calcium gluconate infusions. The 181 procedures were recorded on a total of 135 patients. The overall incidence of thrombosis was 9.9%. The association between calcium chloride or calcium gluconate infusion and thrombotic events was assessed using a generalized linear mixed model for binary data (proc Glimmix, SAS v.9.4, SAS Institute, Cary, NC), to account for within-subjects correlation in patients requiring more than one procedure. The odds of thrombotic events when receiving calcium chloride infusion was 3.45 times that with calcium gluconate infusion in the setting of neonatal cardiac surgery (15% v 4.6%, odds ratio = 3.46, 95% confidence interval= 1.02, 11.7, p = 0.047). Conclusions: In this single-center study, a significant decrease in the odds of an atrial catheter-related thrombus when a calcium gluconate infusion is used instead of calcium chloride was shown. (c) 2025 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)