Intravenous vs. intraosseous access and return of spontaneous circulation during out of hospital cardiac arrest

Clemency, Brian M.; Tanaka, Kaori; May, Paul; Innes, Johanna; Zagroba, Sara; Blaszak, Jacqueline; Hostler, David; Cooney, Derek R; McGee, Kevin M.; Lindstrom, Heather A.

doi:10.1016/j.ajem.2016.10.052

Cited by 43 publications

(17 citation statements)

References 25 publications

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“…Our results also indicated that an IV route should also be established quickly for OHCA patients who have received a first-attempt and successful prehospital IO access. Additionally, our results indirectly supported some currently published evidence that the IV approach appears to be the optimal route for epinephrine administration in advanced life support for OHCA during resuscitation [8][9][10][11][12][13].…”

Section: Ta B L E 3 Logistic Regression For Sustained Rosc With Oddssupporting

confidence: 87%

“…Given the relative ease and speed with which it can be achieved, a higher successful placement rate compared with IV cannulation, and the relatively low procedural risk, intraosseous (IO) access has grown in popularity and is increasingly implemented as a first-line approach for drug administration during cardiac arrest [6,7]. However, recent observational studies support the theory that IV access appears to be the optimal route for epinephrine administration during resuscitation [8][9][10][11][12]. In a 2020 study by Zhang et al [13], where the IV or IO routes of OHCA patients were the first and only attempted route, IO treatment was associated with worse outcomes in comparison to an IV approach.…”

Section: Introductionmentioning

confidence: 99%

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Effect of prehospital intraosseous combined with in-hospital intravenous access in out-of-hospital cardiac arrest

2021

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Objective: Obtaining vascular access during out-of-hospital cardiac arrest (OHCA) is challenging. The aim of this study was to compare the effectiveness of prehospital intraosseous infusion (IO) combined with in-hospital intravenous (IV) (pre-IO + in-IV) access versus the simple IV (pre-IV + in-IV) access in adult OHCA patients who do not achieve prehospital return of spontaneous circulation (ROSC). Methods: This retrospective observational study included adults with OHCA of presumed cardiac etiology between October 1, 2017-October 1, 2020 at an academic emergency department in China. All of the OHCA patients included within the study had Emergency Medical Services cardiopulmonary resuscitation and received prehospital epinephrine administration, but did not achieve prehospital ROSC. The study population were classified as either pre-IO + in-IV or IV (pre-IV + in-IV) based on their epinephrine administration route. The prehospital epinephrine routes were the first and only attempted route. The primary outcome investigated was sustained ROSC following arrival at the emergency department. The secondary outcome considered was the time from dispatch to the first epinephrine dose. Results: Of 193 included adult OHCA subjects who did not have prehospital ROSC, 128 received IV access only. The 65 pre-IO + in-IV-treated patients received epinephrine faster compared to IV-treated patients in terms of the median time from dispatch to the first injection of epinephrine (14.5 vs. 16.0 min, P = 0.001). In the pre-IO + in-IV group, 34 of 65 patients (52.3%) achieved sustained ROSC compared with 65 of 128 (50.8%) patients in the IV group (χ2 = 0.031, P = 0.841). There was no significant difference in sustained ROSC (adjusted OR1.049, 95% CI: 0.425-2.591, P = 0.918) between the two groups. Conclusion: A similar sustained ROSC rate was achieved for both the pre-IO + in-IV access group and the simple IV access group. Our results suggested that an IV route should be established quickly for prehospital IO-treated OHCA patients who do not achieve prehospital ROSC.

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Section: Ta B L E 3 Logistic Regression For Sustained Rosc With Oddssupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Effect of prehospital intraosseous combined with in-hospital intravenous access in out-of-hospital cardiac arrest

2021

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“…Originally developed for battlefield administrations of fluids and analgesics 20 direct intraosseous (i.o.) infusions have become a wide-spread tool in emergency medicine, when peripheral venous access is difficult 21 . Thereby, i.o.…”

Section: Introductionmentioning

confidence: 99%

A network of trans-cortical capillaries as mainstay for blood circulation in long bones

et al. 2019

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Closed circulatory systems (CCS) underlie the function of vertebrate organs, but in long bones their structure is unclear, although they constitute the exit route for bone marrow (BM) leukocytes. To understand neutrophil emigration from BM, we studied the vascular system of murine long bones. Here we show that hundreds of capillaries originate in BM, cross murine cortical bone perpendicularly along the shaft and connect to the periosteal circulation. Structures similar to these trans-cortical-vessels (TCVs) also exist in human limb bones. TCVs express arterial or venous markers and transport neutrophils. Furthermore, over 80% arterial and 59% venous blood passes through TCVs. Genetic and drug-mediated modulation of osteoclast count and activity leads to substantial changes in TCV numbers. In a murine model of chronic arthritic bone inflammation, new TCVs develop within weeks. Our data indicate that TCVs are a central component of the CCS in long bones and may represent an important route for immune cell export from the BM.

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“…Factors such as trauma, peripheral edema, small patient size, and obesity can also increase the difficulty of intravenous (IV) access (5). A recent meta-analysis comparing adults that received epinephrine via IV or IO catheters in out of hospital cardiac arrest scenarios demonstrated that IO catheters provide equivalent return of spontaneous circulation when compared to percutaneous IV catheters (6). Interestingly, there was a higher successful first attempt placement in the IO group when compared to the IV group.…”

Section: Introductionmentioning

confidence: 99%

Intraosseous Catheter Flow Rates and Ease of Placement at Various Sites in Canine Cadavers

Boysen

Bentley²,

Atilla

2019

Front. Vet. Sci.

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Objective: To compare intraosseous catheter placement difficulty, success rates, and flow rates at four different locations in canine cadavers.Design: Prospective study.Setting: Private referral center.Animals: Eleven fresh canine cadavers.Interventions: With owner consent, animals presenting for euthanasia were recruited. Animals received heparin (1,000 IU/kg IV) at least 5 min prior to euthanasia. After euthanasia, EZIO intraosseous catheters were placed into the ilial wing, proximal medial tibia, proximal lateral humerus, and distal lateral femur on one side of the animal. Time to catheter placement and catheter difficulty were scored for each placement site. Sterile saline was infused into each location simultaneously over 5 min, first via gravity then using 300 mmHg pressure. Animals were repositioned onto the contra-lateral side and the experiment repeated.Measurements and Main Results: Placement was successful in 16/22 ilial, 18/22 tibial, and 22/22 femoral and humoral attempts. A post-hoc analysis revealed the ileum had a significantly greater difficulty score when compared to the femur and humerus (p ≤ 0.0001). The femur had a statistically significant faster placement time when compared to the ileum (p ≤ 0.05). Gravity infusion rates were statistically lower in the tibia when compared to humerus (p ≤ 0.01) and between the tibia when compared to the femur (p ≤0.001). Additionally, pressurized infusion rates were statistically lower in the tibia compared to the humerus (p ≤ 0.0001), the femur (p ≤ 0.0001), and the ileum (p ≤ 0.01).Conclusions: The femur and humerus had high success rate for IO catheter placement and low placement time and difficulty scores. Pressurized intraosseous flow rates were highest in the humerus and femur. Contrary to human literature, success rates for catheter placement in the humerus and femur were higher than at other sites, suggesting the humerus and femur may be preferred sites for intraosseous catheter placement in the dog. Further investigation through a larger sample size is required to confirm these findings.

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Intravenous vs. intraosseous access and return of spontaneous circulation during out of hospital cardiac arrest

Cited by 43 publications

References 25 publications

Effect of prehospital intraosseous combined with in-hospital intravenous access in out-of-hospital cardiac arrest

Effect of prehospital intraosseous combined with in-hospital intravenous access in out-of-hospital cardiac arrest

A network of trans-cortical capillaries as mainstay for blood circulation in long bones

Intraosseous Catheter Flow Rates and Ease of Placement at Various Sites in Canine Cadavers

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