Cardiac arrest & resuscitation
The association of intravenous vs. humeral-intraosseous vascular access with patient outcomes in adult out-of-hospital cardiac arrests
Authors' conclusion
An IV-first approach, compared to humeral-IO, for intra-arrest resuscitation was associated with an improved odds of favorable neurological outcomes and survival to hospital discharge.
Study context
- Population
- Adult out-of-hospital cardiac arrest (OHCA) with intra-arrest vascular access by advanced life support (ALS)-trained paramedics, BC Cardiac Arrest Registry
- Participants
- 2,112 participants
- Exposure
- Intravenous (IV) vs humeral-IO first-attempted vascular access
- IVn = 1,575
- Humeral-IOn = 537reference
- Outcome
- Favorable neurological outcome (CPC 1-2) and survival
- Follow-up
- Hospital discharge
Methodological detailsregistry-based, propensity-score adjusted, inverse probability treatment weighting
- Registry-based
- Propensity-score adjusted
- Inverse probability treatment weighting
Main finding
As reported in the abstract
Favorable neurological outcome (CPC 1-2) and survival at hospital discharge
IV vs Humeral-IOAdjusted odds ratio (95% CI)
Favorable neurological outcome
1.7(1.1–2.7)
Survival
1.5(1.0–2.3)
Observational data: associations, not effects.
Further findings
| Outcome | AOR (95% CI) | |
|---|---|---|
| Favorable neurological outcome, by initial rhythm (subgroup)Shockable rhythm | 4.2 (2.1–8.2) | |
| Favorable neurological outcome, by initial rhythm (subgroup)Non-shockable rhythm | 0.73 (0.39–1.4) | |
| 0.10.31310Adjusted odds ratio (log scale) |
min
| Outcome | IV | Humeral-IO |
|---|---|---|
| Time from ALS arrival to vascular access and to epinephrine | ||
| To vascular access | 6.6 | 6.9 |
| To epinephrine | 9.0 | 9.3 |
Time from ALS arrival to vascular access and to epinephrine
- Similar between IV and IO
Original publication
The association of intravenous vs. humeral-intraosseous vascular access with patient outcomes in adult out-of-hospital cardiac arrests. Resuscitation. Published 16 August 2024. doi:10.
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