Intraosseous Versus Intravenous Vascular Access During Out-of-Hospital Cardiac Arrest: A Randomized Controlled Trial Full Text
Annals of Emergency Medicine, 08/22/2011
Reades R et al. – Tibial intraosseous access was found to have the highest first–attempt success for vascular access and the most rapid time to vascular access during out–of–hospital cardiac arrest compared with peripheral intravenous and humeral intraosseous access.Methods
- This was a randomized trial of adult patients experiencing a nontraumatic out–of–hospital cardiac arrest in which resuscitation efforts were initiated.
- Patients were randomized to one of 3 routes of vascular access: tibial intraosseous, humeral intraosseous, or peripheral intravenous.
- Paramedics received intensive training and exposure to all 3 methods before study initiation.
- The primary outcome was first–attempt success, defined as secure needle position in the marrow cavity or a peripheral vein, with normal fluid flow.
- Needle dislodgement during resuscitation was coded as a failure to maintain vascular access.
- There were 182 patients enrolled, with 64 (35%) assigned to tibial intraosseous, 51 (28%) humeral intraosseous, and 67 (37%) peripheral intravenous access.
- Demographic characteristics were similar among patients in the 3 study arms.
- There were 130 (71%) patients who experienced initial vascular access success, with 17 (9%) needles becoming dislodged, for an overall frequency of first–attempt success of 113 (62%).
- Individuals randomized to tibial intraosseous access were more likely to experience a successful first attempt at vascular access (91%; 95% confidence interval [CI] 83% to 98%) compared with either humeral intraosseous access (51%; 95% CI 37% to 65%) or peripheral intravenous access (43%; 95% CI 31% to 55%) groups.
- Time to initial success was significantly shorter for individuals assigned to the tibial intraosseous access group (4.6 minutes; interquartile range 3.6 to 6.2 minutes) compared with those assigned to the humeral intraosseous access group (7.0 minutes; interquartile range 3.9 to 10.0 minutes), and neither time was significantly different from that of the peripheral intravenous access group (5.8 minutes; interquartile range 4.1 to 8.0 minutes).