Vascular access by paramedics during cardiopulmonary resuscitation in out-of-hospital cardiac arrest: A retrospective study of insertion success rates and survival outcomes of intravenous versus intraosseous route.

BACKGROUND

This study investigated insertion patterns, insertion success rates and survival outcomes of out-of-hospital cardiac arrest (OHCA) according to vascular access route using data from an OHCA registry in the state of Queensland, Australia.

METHODS

Included were adult medical OHCA who received a resuscitation attempt from Queensland Ambulance Service (QAS) paramedics and had vascular access attempted intra-arrest between January 2018 and December 2024. Insertion patterns and initial attempt success rates were described. The association between route of vascular access and survival outcomes was investigated with multivariable logistic regression analysis after a match using propensity score.

RESULTS

9854 patients were included. IV was initially attempted in 93.3% of patients, and IO 6.7%. Initial attempt success rate was higher with IO than IV (94.2 versus 68.5%, p < 0.001). After propensity score matching in patients with successful initial access attempt, the IO route had lower return of spontaneous circulation (ROSC) rates, however similar survival to discharge and survival to 30 days rates, compared to the IV route. In patients with successful vascular access regardless of the route and outcome of the initial attempts, the IO route was associated with reduced odds of all survival outcomes.

CONCLUSIONS

QAS paramedics are competent with vascular access with high initial attempt success rates for both IV and IO routes. IO may be associated with reduced odds of ROSC on hospital arrival in patients with successful initial access attempt. This study supports current recommendations preferring IV over IO as the primary vascular access route in adult OHCA.