TY - JOUR
T1 - Intraosseous or Intravenous Vascular Access for Out-of-Hospital Cardiac Arrest
AU - Vallentin, Mikael F.
AU - Granfeldt, Asger
AU - Klitgaard, Thomas L.
AU - Mikkelsen, Søren
AU - Folke, Fredrik
AU - Christensen, Helle Collatz
AU - Povlsen, Amalie L.
AU - Petersen, Alberthe H.
AU - Winther, Sofie
AU - Frilund, Lea W.
AU - Meilandt, Carsten
AU - Holmberg, Mathias J.
AU - Winther, Kristian B.
AU - Bach, Allan
AU - Dissing, Thomas H.
AU - Terkelsen, Christian J.
AU - Christensen, Steffen
AU - Rasmussen, Line Kirkegaard
AU - Mortensen, Lone R.
AU - Loldrup, Mads L.
AU - Elkmann, Thomas
AU - Nielsen, Anders G.
AU - Runge, Charlotte
AU - Klæstrup, Elise
AU - Holm, Jimmy H.
AU - Bak, Mikkel
AU - Nielsen, Lars-Gustav R.
AU - Pedersen, Mette
AU - Kjærgaard-Andersen, Gunhild
AU - Hansen, Peter M.
AU - Brøchner, Anne C.
AU - Christensen, Erika F.
AU - Nielsen, Frederik M.
AU - Nissen, Christian G.
AU - Bjørn, Jeppe W.
AU - Burholt, Peter
AU - Obling, Laust E.R.
AU - Holle, Sarah L.D.
AU - Russell, Lene
AU - Alstrøm, Henrik
AU - Hestad, Søren
AU - Fogtmann, Tanja H.
AU - Buciek, Jens U.H.
AU - Jakobsen, Karina
AU - Krag, Mette
AU - Sandgaard, Michael
AU - Sindberg, Birthe
AU - Andersen, Lars W.
PY - 2025/1/23
Y1 - 2025/1/23
N2 - Background Out-of-hospital cardiac arrest is a leading cause of death worldwide. Establishing vascular access is critical for administering guideline-recommended drugs during cardiopulmonary resuscitation. Both the intraosseous route and the intravenous route are used routinely, but their comparative effectiveness remains unclear. Methods We conducted a randomized clinical trial to compare the effectiveness of initial attempts at intraosseous or intravenous vascular access in adults who had nontraumatic out-of-hospital cardiac arrest. The primary outcome was a sustained return of spontaneous circulation. Key secondary outcomes were survival at 30 days and survival at 30 days with a favorable neurologic outcome, defined by a score of 0 to 3 on the modified Rankin scale (scores range from 0 to 6, with higher scores indicating greater disability). Results Among 1506 patients who underwent randomization, 1479 were included in the primary analysis (731 in the intraosseous-access group and 748 in the intravenous-access group). The successful establishment of vascular access within two attempts occurred in 669 patients (92%) assigned to the intraosseous-access group and in 595 patients (80%) assigned to the intravenous-access group. Sustained return of spontaneous circulation occurred in 221 patients (30%) in the intraosseous-access group and in 214 patients (29%) in the intravenous-access group (risk ratio, 1.06; 95% confidence interval [CI], 0.90 to 1.24; P=0.49). At 30 days, 85 patients (12%) in the intraosseous-access group and 75 patients (10%) in the intravenous-access group were alive (risk ratio, 1.16; 95% CI, 0.87 to 1.56); a favorable neurologic outcome at 30 days occurred in 67 patients (9%) and 59 patients (8%), respectively (risk ratio, 1.16; 95% CI, 0.83 to 1.62). Prespecified adverse events were uncommon. Conclusions There was no significant difference in sustained return of spontaneous circulation between initial intraosseous and intravenous vascular access in adults who had out-of-hospital cardiac arrest.
AB - Background Out-of-hospital cardiac arrest is a leading cause of death worldwide. Establishing vascular access is critical for administering guideline-recommended drugs during cardiopulmonary resuscitation. Both the intraosseous route and the intravenous route are used routinely, but their comparative effectiveness remains unclear. Methods We conducted a randomized clinical trial to compare the effectiveness of initial attempts at intraosseous or intravenous vascular access in adults who had nontraumatic out-of-hospital cardiac arrest. The primary outcome was a sustained return of spontaneous circulation. Key secondary outcomes were survival at 30 days and survival at 30 days with a favorable neurologic outcome, defined by a score of 0 to 3 on the modified Rankin scale (scores range from 0 to 6, with higher scores indicating greater disability). Results Among 1506 patients who underwent randomization, 1479 were included in the primary analysis (731 in the intraosseous-access group and 748 in the intravenous-access group). The successful establishment of vascular access within two attempts occurred in 669 patients (92%) assigned to the intraosseous-access group and in 595 patients (80%) assigned to the intravenous-access group. Sustained return of spontaneous circulation occurred in 221 patients (30%) in the intraosseous-access group and in 214 patients (29%) in the intravenous-access group (risk ratio, 1.06; 95% confidence interval [CI], 0.90 to 1.24; P=0.49). At 30 days, 85 patients (12%) in the intraosseous-access group and 75 patients (10%) in the intravenous-access group were alive (risk ratio, 1.16; 95% CI, 0.87 to 1.56); a favorable neurologic outcome at 30 days occurred in 67 patients (9%) and 59 patients (8%), respectively (risk ratio, 1.16; 95% CI, 0.83 to 1.62). Prespecified adverse events were uncommon. Conclusions There was no significant difference in sustained return of spontaneous circulation between initial intraosseous and intravenous vascular access in adults who had out-of-hospital cardiac arrest.
KW - Cardiac Arrest
KW - Cardiology
KW - Clinical Medicine
KW - Clinical Medicine General
KW - Critical Care
KW - Emergency Medicine
KW - Emergency Medicine General
KW - Pulmonary/Critical Care
UR - http://www.scopus.com/inward/record.url?scp=85214563180&partnerID=8YFLogxK
U2 - 10.1056/NEJMoa2407616
DO - 10.1056/NEJMoa2407616
M3 - Journal article
SN - 0028-4793
VL - 392
SP - 349
EP - 360
JO - The New England Journal of Medicine
JF - The New England Journal of Medicine
IS - 4
ER -