The Way to a Patient’s Heart — Vascular Access in Cardiac Arrest

This editorial reviews two randomized clinical trials evaluating vascular access strategies for drug delivery during cardiopulmonary resuscitation in out-of-hospital cardiac arrest. The PARAMEDIC-3 trial (United Kingdom) and the IVIO trial (Denmark) compared intraosseous and intravenous vascular access as first-line approaches. Despite differences in primary endpoints survival at 30 days for PARAMEDIC-3 and sustained return of spontaneous circulation for IVIO both studies found no significant advantage in survival outcomes between intraosseous and intravenous access.

While intraosseous access offers higher first-attempt success rates, it carries potential downsides such as slower drug infusion, risk of infection, and higher costs. Conversely, intravenous access is favored in guidelines, with intraosseous access recommended only if intravenous attempts fail. Data from both trials reinforce existing recommendations to prioritize intravenous access first. The editorial calls for further meta-analyses and economic evaluations to refine CPR protocols and optimize emergency medical responses.

This editorial reviews two randomized clinical trials evaluating vascular access strategies for drug delivery during cardiopulmonary resuscitation in out-of-hospital cardiac arrest. The PARAMEDIC-3 trial (United Kingdom) and the IVIO trial (Denmark) compared intraosseous and intravenous vascular access as first-line approaches. Despite differences in primary endpoints survival at 30 days for PARAMEDIC-3 and sustained return of spontaneous circulation for IVIO both studies found no significant advantage in survival outcomes between intraosseous and intravenous access.

While intraosseous access offers higher first-attempt success rates, it carries potential downsides such as slower drug infusion, risk of infection, and higher costs. Conversely, intravenous access is favored in guidelines, with intraosseous access recommended only if intravenous attempts fail. Data from both trials reinforce existing recommendations to prioritize intravenous access first. The editorial calls for further meta-analyses and economic evaluations to refine CPR protocols and optimize emergency medical responses.