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The association of intravenous vs. humeral-intraosseous vascular access with patient outcomes in adult out-of-hospital cardiac arrests.
Brebner, Callahan; Asamoah-Boaheng, Michael; Zaidel, Bianca; Yap, Justin; Scheuermeyer, Frank; Mok, Valerie; Hutton, Jacob; Meckler, Garth; Schlamp, Robert; Christenson, Jim; Grunau, Brian.
Afiliación
  • Brebner C; British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada.
  • Asamoah-Boaheng M; British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada; Centre for Advancing Health Outcomes, St. Paul's
  • Zaidel B; Faculty of Medicine, University of British Columbia, British Columbia, Canada.
  • Yap J; British Columbia Resuscitation Research Collaborative, British Columbia, Canada.
  • Scheuermeyer F; British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada; Centre for Advancing Health Outcomes, St. Paul's
  • Mok V; British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada.
  • Hutton J; British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada; British Columbia Emergency Health Services, Brit
  • Meckler G; British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada.
  • Schlamp R; British Columbia Resuscitation Research Collaborative, British Columbia, Canada; British Columbia Emergency Health Services, British Columbia, Canada.
  • Christenson J; British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada; Centre for Advancing Health Outcomes, St. Paul's
  • Grunau B; British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada; Centre for Advancing Health Outcomes, St. Paul's
Resuscitation ; 202: 110360, 2024 Sep.
Article en En | MEDLINE | ID: mdl-39154890
ABSTRACT

AIM:

While intravenous (IV) vascular access for out-of-hospital cardiac arrest (OHCA) resuscitation is standard, humeral-intraosseous (IO) access is commonly used, despite few supporting data. We investigated the association between IV vs. humeral-IO and outcomes.

METHODS:

We utilized BC Cardiac Arrest Registry data, including adult OHCA where the first-attempted intra-arrest vascular access route performed by advanced life support (ALS)-trained paramedics was IV or humeral-IO. We fit a propensity-score adjusted model with inverse probability treatment weighting to estimate the association between IV vs. humeral-IO routes and favorable neurological outcomes (CPC 1-2) and survival at hospital discharge. We repeated models within subgroups defined by initial cardiac rhythm.

RESULTS:

We included 2,112 cases; the first-attempted route was IV (n = 1,575) or humeral-IO (n = 537). Time intervals from ALS-paramedic on-scene arrival to vascular access (6.6 vs. 6.9 min) and epinephrine administration (9.0 vs. 9.3 min) were similar between IV and IO groups, respectively. Among IV and humeral-IO groups, 98 (6.2%) and 20 (3.7%) had favorable neurological outcomes. Compared to humeral-IO, an IV-first approach was associated with improved hospital-discharge favorable neurological outcomes (AOR 1.7; 95% CI 1.1-2.7) and survival (AOR 1.5; 95% CI 1.0-2.3). Among shockable rhythm cases, an IV-first approach was associated with improved favorable neurological outcomes (AOR 4.2; 95% CI 2.1-8.2), but not among non-shockable rhythm cases (AOR 0.73; 95% CI 0.39-1.4).

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. This association was seen among an initial shockable rhythm, but not non-shockable rhythm, subgroups.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Sistema de Registros / Reanimación Cardiopulmonar / Infusiones Intraóseas / Paro Cardíaco Extrahospitalario Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Resuscitation Año: 2024 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Irlanda
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Sistema de Registros / Reanimación Cardiopulmonar / Infusiones Intraóseas / Paro Cardíaco Extrahospitalario Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Resuscitation Año: 2024 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Irlanda