Intraosseous versus intravenous access in patients with out-of-hospital cardiac arrest: Insights from the resuscitation outcomes consortium continuous chest compression trial
Intraosseous versus intravenous access in patients with out-of-hospital cardiac arrest: Insights from the resuscitation outcomes consortium continuous chest compression trial
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DOI：
10.1016/j.resuscitation.2018.10.031
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发表时间：
2019-01-01
期刊：
影响因子：
6.5
通讯作者：
Idris, Ahamed H.
中科院分区：
文献类型：
--
作者：
Mody, Purav;Brown, Siobhan P.;Idris, Ahamed H.
目的：研究院外心脏骤停（OHCA）复苏期间尝试骨内入路输送药物的相关结局。使用来自连续胸部按压试验的数据，我们检查了在调整年龄后，骨内和静脉内通路尝试患者的出院生存率、持续自主循环恢复（ROSC）和神经功能良好的生存率，结果：在19,731例患者中，分别有3068例和16,663例患者尝试了骨内入路和静脉入路。尝试骨内入路的患者更年轻，女性更常见，初次入路和首次给药的时间略快。与静脉入路相比，尝试骨内入路的患者的未校正结局显著较低：出院生存率（4.6% vs. 5.7%，p = 0.01），持续ROSC（17.9% vs. 23.5%，p < 0.001）和神经功能良好的生存率（2.8% vs. 4.2%，p < 0.001）。校正后，尝试骨内入路（与静脉入路）的患者的住院生存率（OR，0.88，95% CI 0.72-1.09，p = 0.24）或神经功能良好的生存率（OR，0.87，95% CI 0.67-1.12，p = 0.29）无差异。然而，骨内入路仍与持续ROSC发生率较低相关（OR，0.80，95%CI 0.71-0.89，p < 0.001）。结论：在OHCA患者中，骨内入路尝试与ROSC发生率较差相关，但生存率无差异。进一步的研究是必要的，以阐明OHCA患者的最佳访问路径。
Aim: To examine outcomes associated with intraosseous access route attempt for delivery of medications during out-of-hospital cardiac arrest (OHCA) resuscitation.Methods: Using data from the Continuous Chest Compression trial, we examined rates of survival to hospital discharge, sustained return of spontaneous circulation (ROSC), and survival with favorable neurological function among patients with intraosseous and intravenous access attempts after adjusting for age, sex, initial rhythm, bystander cardiopulmonary resuscitation, public location, witnessed status, EMS response and trial randomization cluster.Results: Among 19,731 patients, intraosseous access was attempted in 3068 patients and intravenous access in 16,663 patients respectively. Patients in whom intraosseous access was attempted were younger, more often female, and had marginally faster times to initial access and to initial drug administration. Unadjusted outcomes were significantly lower in patients with attempted intraosseous access compared with intravenous access: (4.6% vs. 5.7%, p = 0.01) for survival to discharge, (17.9% vs. 23.5%, p < 0.001) for sustained ROSC and (2.8% vs. 4.2%, p < 0.001) for survival with favorable neurological function. After adjustment, there were no differences in hospital survival (OR, 0.88, 95% CI 0.72-1.09, p = 0.24) or survival with favorable neurological function (OR, 0.87, 95% CI 0.67-1.12, p = 0.29) in patients with intraosseous access attempt (vs. intravenous access). However, intraosseous access continued to associate with lower rates of sustained ROSC (OR, 0.80, 95% CI 0.71-0.89, p < 0.001).Conclusions: Among patients with OHCA, intraosseous access attempt was associated with worse ROSC rates but no difference in survival. Further studies are necessary to elucidate the optimal access route among OHCA patients.