Pediatric anesthesia & critical care
Intraosseous vs Intravenous Access for Epinephrine in Pediatric Out-of-Hospital Cardiac Arrest
Main finding · Survival to hospital dischargeResult — go to the resultRR for survival to hospital discharge 0.92 95% CI 0.41–2.07Authors' conclusion
In this retrospective cohort study of pediatric patients with OHCA in the US and Canada, the route of epinephrine administration was not associated with survival to hospital discharge or prehospital ROSC.
Study context
- Population
- Children (<18 years) with nontraumatic out-of-hospital cardiac arrest (OHCA) treated by EMS who received prehospital epinephrine, Resuscitation Outcomes Consortium Epidemiologic Registry, 10 sites in US and Canada, 2011–2015740 inverse probability of treatment weighting (IPTW)-weighted cases
- Participants
- 739 children
- Exposure
- Intraosseous (IO) vs intravenous (IV) epinephrine administration
- IOn = 535
- IVn = 204reference
- Outcome
- Survival to hospital discharge
Methodological detailspropensity-score IPTW with stabilized weights, multicentre registry
- Propensity-score IPTW with stabilized weights
- Multicentre registry
Main finding
As reported in the abstract
RR for survival to hospital discharge
0.92
95% CI 0.41–2.07
Events by group
IO epinephrine vs IV epinephrine
RR for survival to hospital discharge 0.92 (95% CI 0.41–2.07)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | IO epinephrine | IV epinephrine | RR for prehospital ROSC (95% CI) | |
|---|---|---|---|---|
| Prehospital ROSC · before hospital arrival | 14.4% | 21.7% | 0.66 (0.42–1.03) | |
| 0.512RR for prehospital ROSC (log scale) |
- Prehospital return of spontaneous circulation (ROSC): IPTW pseudopopulation (740 weighted cases)
- Prehospital ROSC: IO: 76 of 528; IV: 46 of 212 weighted
Original publication
Intraosseous vs Intravenous Access for Epinephrine in Pediatric Out-of-Hospital Cardiac Arrest. JAMA Netw Open. Published 2 June 2025. doi:10.
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