Intraosseous or Intravenous Vascular Access for Out-of-Hospital Cardiac Arrest.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
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Vallentin Mikael F, Granfeldt Asger, Klitgaard Thomas L, Mikkelsen Søren, Folke Fredrik, Christensen Helle C, Povlsen Amalie L, Petersen Alberthe H, Winther Sofie, Frilund Lea W, Meilandt Carsten, Holmberg Mathias J, Winther Kristian B, Bach Allan, Dissing Thomas H, Terkelsen Christian J, Christensen Steffen, Kirkegaard Rasmussen Line, Mortensen Lone R, Loldrup Mads L, Elkmann Thomas, Nielsen Anders G, Runge Charlotte, Klæstrup Elise, Holm Jimmy H, Bak Mikkel, Nielsen Lars-Gustav R, Pedersen Mette, Kjærgaard-Andersen Gunhild, Hansen Peter M, Brøchner Anne C, Christensen Erika F, Nielsen Frederik M, Nissen Christian G, Bjørn Jeppe W, Burholt Peter, Obling Laust E R, Holle Sarah L D, Russell Lene, Alstrøm Henrik, Hestad Søren, Fogtmann Tanja H, Buciek Jens U H, Jakobsen Karina, Krag Mette, Sandgaard Michael, Sindberg Birthe, Andersen Lars W
Аннотация
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. (Funded by the Novo Nordisk Foundation and others; IVIO EU Clinical Trials Register number, 2022-500744-38-00; ClinicalTrials.gov number, NCT05205031.).