A Randomized Trial of Drug Route in Out-of-Hospital Cardiac Arrest.
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Couper Keith, Ji Chen, Deakin Charles D, Fothergill Rachael T, Nolan Jerry P, Long John B, Mason James M, Michelet Felix, Norman Chloe, Nwankwo Henry, Quinn Tom, Slowther Anne-Marie, Smyth Michael A, Starr Kath R, Walker Alison, Wood Sara, Bell Steve, Bradley Gemma, Brown Martina, Brown Shona, Burrow Emma, Charlton Karl, Claxton Dip Andrew, Dra'gon Victoria, Evans Christine, Falloon Jakob, Foster Theresa, Kearney Justin, Lang Nigel, Limmer Matthew, Mellett-Smith Adam, Miller Joshua, Mills Carla, Osborne Ria, Rees Nigel, Spaight Robert E S, Squires Gemma L, Tibbetts Belinda, Waddington Michelle, Whitley Gregory A, Wiles Jason V, Williams Julia, Wiltshire Sarah, Wright Adam, Lall Ranjit, Perkins Gavin D, PARAMEDIC-3 Collaborators
Аннотация
METHODS: We conducted a multicenter, open-label, randomized trial across 11 emergency medical systems in the United Kingdom that involved adults in cardiac arrest for whom vascular access for drug administration was needed. Patients were randomly assigned to receive treatment from paramedics by means of an intraosseous-first or intravenous-first vascular access strategy. The primary outcome was survival at 30 days. Key secondary outcomes included any return of spontaneous circulation and favorable neurologic function at hospital discharge (defined by a score of 3 or less on the modified Rankin scale, on which scores range from 0 to 6, with higher scores indicating greater disability). No adjustment for multiplicity was made.
RESULTS: A total of 6082 patients were assigned to a trial group: 3040 to the intraosseous group and 3042 to the intravenous group. At 30 days, 137 of 3030 patients (4.5%) in the intraosseous group and 155 of 3034 (5.1%) in the intravenous group were alive (adjusted odds ratio, 0.94; 95% confidence interval [CI], 0.68 to 1.32; P = 0.74). At the time of hospital discharge, a favorable neurologic outcome was observed in 80 of 2994 patients (2.7%) in the intraosseous group and in 85 of 2986 (2.8%) in the intravenous group (adjusted odds ratio, 0.91; 95% CI, 0.57 to 1.47); a return of spontaneous circulation at any time occurred in 1092 of 3031 patients (36.0%) and in 1186 of 3035 patients (39.1%), respectively (adjusted odds ratio, 0.86; 95% CI, 0.76 to 0.97). During the trial, one adverse event, which occurred in the intraosseous group, was reported.
CONCLUSIONS: Among adults with out-of-hospital cardiac arrest requiring drug therapy, the use of an intraosseous-first vascular access strategy did not result in higher 30-day survival than an intravenous-first strategy. (Funded by the National Institute for Health and Care Research; PARAMEDIC-3 ISRCTN Registry number, ISRCTN14223494.).