IVIO
Trial question
What is the role of intraosseous vascular access in patients who had out-of-hospital cardiac arrest?
Study design
Multi-center
Single blinded
RCT
Population
Characteristics of study participants
30.0% female
70.0% male
N = 1479
1479 patients (446 female, 1033 male).
Inclusion criteria: adult patients who had nontraumatic out-of-hospital cardiac arrest.
Key exclusion criteria: suspected traumatic cause of the cardiac arrest; functioning vascular access already in place at the time of possible randomization.
Interventions
N=731 intraosseous access (needle placed in the bone marrow either in the humerus or tibia).
N=748 intravenous access (needle placed in a vein).
Primary outcome
Sustained return of spontaneous circulation
30%
29%
30.0 %
22.5 %
15.0 %
7.5 %
0.0 %
Intraosseous
access
Intravenous
access
No significant
difference ↔
No significant difference in sustained return of spontaneous circulation (30% vs. 29%; RR 1.06, 95% CI 0.9 to 1.24).
Secondary outcomes
No significant difference in survival at day 30 (12% vs. 10%; RR 1.16, 95% CI 0.87 to 1.56).
No significant difference in favorable neurologic outcome at day 30 (9% vs. 8%; RR 1.16, 95% CI 0.83 to 1.62).
No significant difference in EuroQoL Group 5-Dimension 5-Level questionnaire score, as assessed by the patient (68 points vs. 64 points; MD 4, 95% CI -2 to 11).
Safety outcomes
No significant difference in adverse events.
Conclusion
In adult patients who had nontraumatic out-of-hospital cardiac arrest, intraosseous access was not superior to intravenous access with respect to sustained return of spontaneous circulation.
Reference
Mikael F Vallentin, Asger Granfeldt, Thomas L Klitgaard et al. Intraosseous or Intravenous Vascular Access for Out-of-Hospital Cardiac Arrest. N Engl J Med. 2025 Jan 23;392(4):349-360.
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