Intraosseous or Intravenous Vascular Access for Out-of-Hospital Cardiac Arrest

Out-of-hospital cardiac arrest is a leading global cause of mortality, necessitating rapid vascular access for the administration of resuscitative medications. Both intraosseous and intravenous routes are commonly used, yet comparative effectiveness remains unclear. This randomized clinical trial, conducted across Denmark, aimed to determine whether intraosseous or intravenous vascular access leads to higher rates of sustained return of spontaneous circulation. Among 1,479 patients randomized to either intraosseous (n=731) or intravenous (n=748) access, successful vascular access within two attempts was achieved in 92% of the intraosseous group and 80% of the intravenous group. However, sustained return of spontaneous circulation occurred in 30% and 29% of patients in the intraosseous and intravenous groups, respectively, demonstrating no significant difference. Similarly, survival at 30 days (12% vs. 10%) and favorable neurologic outcomes (9% vs. 8%) showed no notable differences between groups. The findings suggest that both intraosseous and intravenous access methods are viable for advanced cardiac resuscitation without a clear superiority.

Out-of-hospital cardiac arrest is a leading global cause of mortality, necessitating rapid vascular access for the administration of resuscitative medications. Both intraosseous and intravenous routes are commonly used, yet comparative effectiveness remains unclear. This randomized clinical trial, conducted across Denmark, aimed to determine whether intraosseous or intravenous vascular access leads to higher rates of sustained return of spontaneous circulation. Among 1,479 patients randomized to either intraosseous (n=731) or intravenous (n=748) access, successful vascular access within two attempts was achieved in 92% of the intraosseous group and 80% of the intravenous group. However, sustained return of spontaneous circulation occurred in 30% and 29% of patients in the intraosseous and intravenous groups, respectively, demonstrating no significant difference. Similarly, survival at 30 days (12% vs. 10%) and favorable neurologic outcomes (9% vs. 8%) showed no notable differences between groups. The findings suggest that both intraosseous and intravenous access methods are viable for advanced cardiac resuscitation without a clear superiority.