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Intraosseous Versus Peripheral Intravenous Access During Out-of-Hospital Cardiac Arrest: a Comparison of 30-Day Survival and Neurological Outcome in the French National Registry

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Abstract

Purpose

To compare intraosseous access with peripheral venous access on adults out-of-hospital cardiac arrest (OHCA) patients’ clinical outcomes.

Methods

A national retrospective multicentre study was conducted based on the French National Cardiac Arrest Registry. Comparison of patients (intraosseous vs. peripheral venous access) was conducted before and after a matching using a propensity score. The propensity score included confounding factors: age, time between the call (T0) to epinephrine (to take account of how quickly vascular access was achieved), the aetiology of OHCA, the shock and the patient initial rhythm at MMT arrival.

Results

A total of 1576 patients received intraosseous access, and 27,280 received peripheral intravenous access. Before matching, OHCA patients with intraosseous access were less likely to survive at all stages (return of spontaneous circulation (ROSC), 0-day survival and 30-day survival). No significant difference in neurological outcome was observed. After propensity score matching, no significant differences in 30-day survival rates (OR = 0.763 [0.473;1.231]) and neurological outcome (OR = 1.296 [0.973;1.726]) were observed. However, intraosseous patients still showed lower likelihood of short-term survival (ROSC and 0-day survival) even after propensity score matching was implemented.

Conclusion

The populations we investigated were similar to those of other studies suggesting that intraosseous access is associated with reduced survival and poorer neurological outcome. Our findings suggest that intraosseous access is a comparably effective alternative to peripheral intravenous access for treating OHCA patients on matched populations.

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References

  1. Henning N. Intrasternal injections and transfusions. JAMA. 1945;128:240.

    Google Scholar 

  2. Orlowski JP. My kingdom for an intravenous line. Am J Diseases Children. 1984;138:803.

    CAS  Google Scholar 

  3. Orlowski JP. The effectiveness of pediatric cardiopulmonary resuscitation. Am J Diseases Children. 1984;138:1098.

    Google Scholar 

  4. Zaritsky A. Advanced pediatric life support: state of the art. Circulation. 1986;74:IV124–8.

    CAS  PubMed  Google Scholar 

  5. Orlowski JP, Gallagher JM, Porembka DT. Endotracheal epinephrine is unreliable. Resuscitation. 1990;19:103–13.

    Article  CAS  Google Scholar 

  6. Nolan JP, Deakin CD, Soar J, Böttiger BW, Smith G. European resuscitation council guidelines for. Resuscitation. 2005;67:S39–6.

    Article  Google Scholar 

  7. Hurren JS, Dunn KW. Intraosseous infusion for burns resuscitation. Burns. 1995;21:285–7.

    Article  CAS  Google Scholar 

  8. Dubick MA, Holcomb JB. A review of intraosseous vascular access: current status and military application. Mil Med. 2000;165:552–9.

    Article  CAS  Google Scholar 

  9. Reades R, Studnek JR, Vandeventer S, Garrett J. Intraosseous versus intravenous vascular access during out-of-hospital cardiac arrest: a randomized controlled trial. Ann Emerg Med. 2011;58:509–16.

    Article  Google Scholar 

  10. Szarpak L, Truszewski Z, Fudalej M, Krajewski P. The intraosseous access devices as a method of vascular access during cardiopulmonary resuscitation. Am J Emerg Med. 2016;34:321–2.

    Article  Google Scholar 

  11. Slovis CM, Herr EW, Londorf D, Little TD, Alexander BR, Guthmann RJ. Success rates for initiation of intravenous therapy en route by prehospital care providers. Am J Emerg Med. 1990;8:305–7.

    Article  CAS  Google Scholar 

  12. Szarpak L, Truszewski Z, Smereka J, Krajewski P, Fudalej M, Madziala M. Ability of paramedics to perform intraosseous access. A randomized cadaver study comparing EZ-IO® and NIO® devices. Resuscitation. 2016;104:e5–6.

    Article  Google Scholar 

  13. Maconochie IK, Bingham R, Eich C, López-Herce J, Rodríguez-Núñez A, Rajka T, et al. European resuscitation council guidelines for resuscitation 2015: section 6. Paediatric life support. Resuscitation. 2015;95:223–48.

    Article  Google Scholar 

  14. Biarent D, Bingham R, Eich C, López-Herce J, Maconochie I, Rodríguez-Núñez A, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 6. Paediatric life support. Resuscitation. 2010;81:1364–88.

    Article  Google Scholar 

  15. Soar J, Nolan JP, Böttiger BW, Perkins GD, Lott C, Carli P, et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support. Resuscitation. 2015;95:100–47.

    Article  Google Scholar 

  16. Hoskins SL, Do Nascimento P, Lima RM, Espana-Tenorio JM, Kramer GC. Pharmacokinetics of intraosseous and central venous drug delivery during cardiopulmonary resuscitation. Resuscitation. 2012;83:107–12.

    Article  CAS  Google Scholar 

  17. Johnson D, Garcia-Blanco J, Burgert J, Fulton L, Kadilak P, Perry K, et al. Effects of humeral intraosseous versus intravenous epinephrine on pharmacokinetics and return of spontaneous circulation in a porcine cardiac arrest model: a randomized control trial. Ann Med Surg. 2015;4:306–10.

    Article  Google Scholar 

  18. Chin YX, Tan KBK, Koh ZX, Ng YY, Said NAZBM, Rahmat M, et al. Comparing intraosseous and intravenous access for out-of-hospital cardiac arrest in Singapore. Resuscitation. 2016;106:e25.

    Article  Google Scholar 

  19. Wong MR, Reggio MJ, Morocho FR, Holloway MM, Garcia-Blanco JC, Jenkins C, et al. Effects of intraosseous epinephrine in a cardiac arrest swine model. J Surg Res. 2016;201:327–33.

    Article  CAS  Google Scholar 

  20. Burgert JM, Johnson AD, Garcia-Blanco J, Froehle J, Morris T, Althuisius B, et al. The effects of proximal and distal routes of intraosseous epinephrine administration on short-term resuscitative outcome measures in an adult swine model of ventricular fibrillation: a randomized controlled study. Am J Emerg Med. 2016;34:49–53.

    Article  Google Scholar 

  21. O’Sullivan M, Martinez A, Long A, Johnson M, Blouin D, Johnson AD, et al. Comparison of the effects of sternal and tibial intraosseous administered resuscitative drugs on return of spontaneous circulation in a swine model of cardiac arrest. Am J Disaster Med. 2016;11:175–82.

    Article  Google Scholar 

  22. Clemency B, Tanaka K, May P, Innes J, Zagroba S, Blaszak J, et al. Intravenous vs. intraosseous access and return of spontaneous circulation during out of hospital cardiac arrest. Am J Emerg Med. 2017;35:222–6.

    Article  Google Scholar 

  23. Feinstein BA, Stubbs BA, Rea T, Kudenchuk PJ. Intraosseous compared to intravenous drug resuscitation in out-of-hospital cardiac arrest. Resuscitation. 2017;117:91–6.

    Article  Google Scholar 

  24. Kawano T, Grunau B, Scheuermeyer FX, Gibo K, Fordyce CB, Lin S, et al. Intraosseous vascular access is associated with lower survival and neurologic recovery among patients with out-of-hospital cardiac arrest. Ann Emerg Med. 2018;71:588–96.

    Article  Google Scholar 

  25. Adnet F, Lapostolle F. International EMS systems: France. Resuscitation. 2004;63:7–9.

    Article  Google Scholar 

  26. Hubert H, Tazarourte K, Wiel E, Zitouni D, Vilhelm C, Escutnaire J, et al. Rationale, methodology, implementation, and first results of the French out-of-hospital cardiac arrest registry. Prehospital Emerg Care. 2014;18:511–9.

    Article  Google Scholar 

  27. Perkins GD, Jacobs IG, Nadkarni VM, Berg RA. Bhanji Farhan, Biarent Dominique, et al. cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the Utstein resuscitation registry templates for out-of-hospital cardiac arrest. Circulation. 2015;132:1286–300.

    Article  Google Scholar 

  28. Mattei A. Estimating and using propensity score in presence of missing background data: an application to assess the impact of childbearing on wellbeing. Stat Methods Appl. 2009;18:257–73.

    Article  Google Scholar 

  29. Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar Behav Res. 2011;46:399–424.

    Article  Google Scholar 

  30. Austin PC. A comparison of 12 algorithms for matching on the propensity score. Stat Med. 2014;33:1057–69.

    Article  Google Scholar 

  31. Austin PC. Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med. 2009;28:3083–107.

    Article  Google Scholar 

  32. Santos D, Carron P-N, Yersin B, Pasquier M. EZ-IO® intraosseous device implementation in a pre-hospital emergency service: a prospective study and review of the literature. Resuscitation. 2013;84:440–5.

    Article  Google Scholar 

  33. Petitpas F, Guenezan J, Vendeuvre T, Scepi M, Oriot D, Mimoz O. Use of intra-osseous access in adults: a systematic review. Crit Care. 2016;20:102.

    Article  CAS  Google Scholar 

  34. Morales-Cané I, Valverde-León MDR, Rodríguez-Borrego MA, López-Soto PJ. Intraosseous access in adults in cardiac arrest: a systematic review and meta-analysis. Emergencias. 2020;32:49–56.

    PubMed  Google Scholar 

  35. McNally B. The importance of cardiac arrest registries. Scandinavian journal of trauma, resuscitation and. Emerg Med. 2014;22:A3.

    Google Scholar 

  36. Eisenberg MS. Resuscitate!: how your community can improve survival from sudden cardiac arrest. University of Washington Press; 2013.

  37. Gueugniaud P-Y, Bertrand C, Savary D, Hubert H. L’arrêt cardiaque en France : pourquoi un registre national ? Presse Med. 2011;40:634–8.

    Article  Google Scholar 

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Funding

The French National Cardiac Arrest Registry (RéAC) is supported by the French Society of Emergency Medicine (SFMU); a patient foundation, the Fédération Française de Cardiologie; the Mutuelle Générale de l’Education Nationale (MGEN); Lille University; and the northern region and the European community via FEDER funds.

Author information

Authors and Affiliations

  1. Univ. Lille, CHU Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, University of Lille, F-59000, Lille, France

    Valentine Baert, Christian Vilhelm, Joséphine Escutnaire, Eric Wiel & Hervé Hubert

  2. French national out-of-hospital cardiac arrest registry - Registre électronique des Arrêts Cardiaques, Lille, France

    Valentine Baert, Christian Vilhelm, Joséphine Escutnaire & Hervé Hubert

  3. RESCUe – RESUVal Networks, Lucien Hyssel Hospital, Vienne, France

    Valentine Baert & Carlos El Khoury

  4. Emergency Medicine Department and SAMU 59, Lille University Hospital, Lille, France

    Sophie Nave & Eric Wiel

  5. Department of Emergency Medicine, SAMU 69, Hospital Edouard Herriot, University hospital of Lyon, Lyon, France

    Delphine Hugenschmitt & Karim Tazarourte

  6. Emergency Department, University Hospital of Nancy, Nancy, France

    Tahar Chouihed

  7. INSERM U1116, Université de Lorraine, Nancy, France

    Tahar Chouihed

  8. F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France

    Tahar Chouihed

  9. INSERM, Clinical Investigation Center – Unit 1433, University Hospital of Nancy, Vandoeuvre les, Nancy, France

    Tahar Chouihed

  10. Health Services and Performance Research, HESPER, EA7425, Claude Bernard University, 1, Lyon, France

    Karim Tazarourte

  11. SAMU 44, Department of Emergency Medicine, University Hospital of Nantes, France & University of Nantes, Microbiotas Hosts Antibiotics and bacterial Resistances (MiHAR), University of Nantes, Nantes, France

    François Javaudin

  12. Emergency Department and Clinical Research Unit, Médipôle Hospital, Villeurbanne, France

    Carlos El Khoury

Authors
  1. Valentine Baert
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  2. Christian Vilhelm
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on behalf of the GR-RéAC

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Correspondence to Valentine Baert.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Baert, V., Vilhelm, C., Escutnaire, J. et al. Intraosseous Versus Peripheral Intravenous Access During Out-of-Hospital Cardiac Arrest: a Comparison of 30-Day Survival and Neurological Outcome in the French National Registry. Cardiovasc Drugs Ther 34, 189–197 (2020). https://doi.org/10.1007/s10557-020-06952-8

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  • DOI: https://doi.org/10.1007/s10557-020-06952-8

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