Effect of vascular access strategy on long-term outcomes in patients with out-of-hospital cardiac arrest: a randomised clinical trial.
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Vallentin Mikael Fink, Holmberg Mathias J, Granfeldt Asger, Klitgaard Thomas Lass, Mikkelsen Søren, Folke Fredrik, Christensen Helle Collatz, Povlsen Amalie Ling, Petersen Alberthe Hjort, Winther Sofie, Frilund Lea Wildt, Meilandt Carsten, Winther Kristian Blumensaadt, Bach Allan, Dissing Thomas H, Terkelsen Christian Juhl, Christensen Steffen, Rasmussen Line Kirkegaard, Mortensen Lone Riis, Elkmann Thomas, Nielsen Anders Gunnar, Runge Charlotte, Klæstrup Elise, Holm Jimmy Højberg, Bak Mikkel, Nielsen Lars-Gustav Rahbek, Pedersen Mette, Kjærgaard-Andersen Gunhild, Hansen Peter Martin, Brøchner Anne Craveiro, Christensen Erika Frischknecht, Nielsen Frederik Mølgaard, Nissen Christian Gade, Bjørn Jeppe Waldstrøm, Burholt Peter, Obling Laust E R, Duus Holle Sarah Louise, Russell Lene, Alstrøm Henrik, Hestad Søren, Hove Buciek Jens Ulrik, Jakobsen Karina, Krag Mette, Sandgaard Michael, Sindberg Birthe, Andersen Lars W
Аннотация
METHODS: Adults with non-traumatic out-of-hospital cardiac arrest, in whom vascular access was indicated, were randomised to initial intraosseous or intravenous access. The allocated method was attempted up to two times. Prespecified 6-months and 1-year outcomes included survival, survival with a favourable neurological outcome, defined as a modified Rankin Scale score of 0-3, and health-related quality-of-life assessed using the EuroQoL 5-Dimension 5-Level questionnaire on domains of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression.
RESULTS: Of the 1479 patients included in the main manuscript primary analyses, three were lost to follow-up for 1-year survival. At 1 year, 82 patients (11%) in the intraosseous group and 68 patients (9%) in the intravenous group were alive (risk ratio 1.24; 95% confidence interval 0.91-1.67). Survival with a favourable neurological outcome was observed in 76 patients (10%) and 61 patients (8%), respectively (risk ratio 1.28; 95% confidence interval 0.93-1.77). Among survivors, the mean EQ-5D-5L numeric score was 83 in the intraosseous group and 76 in the intravenous group (mean difference 7; 95% confidence interval 1-13).
CONCLUSION: Long-term outcomes were similar between patients who received initial intraosseous versus intravenous vascular access during adult out-of-hospital cardiac arrest. These findings do not support a difference in patient outcomes between the two vascular access strategies.
TRIAL REGISTRATION: EU Clinical Trials number 2022-500744-38-00; ClinicalTrials.gov number NCT05205031.