PARAMEDIC-3
Trial question
What is the role of intraosseous-first vascular access strategy in patients with out-of-hospital cardiac arrest requiring drug therapy?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
36.0% female
64.0% male
N = 6082
6082 patients (2190 female, 3892 male).
Inclusion criteria: adult patients with out-of-hospital cardiac arrest requiring drug therapy.
Key exclusion criteria: pregnancy; age < 18 years; pre-existing vascular access.
Interventions
N=3040 intraosseous route (needle inserted into a bone by a paramedic).
N=3042 intravenous route (needle inserted into a vein by a paramedic).
Primary outcome
Survival at day 30
4.5%
5.1%
5.1 %
3.8 %
2.5 %
1.3 %
0.0 %
Intraosseous
route
Intravenous
route
No significant
difference ↔
No significant difference in survival at day 30 (4.5% vs. 5.1%; OR 0.94, 95% CI 0.68 to 1.32).
Secondary outcomes
No significant difference in favorable neurologic outcome (2.7% vs. 2.8%; OR 0.91, 95% CI 0.57 to 1.47).
Significant decrease in return of spontaneous circulation at any time (36% vs. 39.1%; OR 0.86, 95% CI 0.76 to 0.97).
Significant decrease in sustained return of spontaneous circulation at hospital handover (21.7% vs. 24.6%; OR 0.85, 95% CI 0.74 to 0.98).
Safety outcomes
No significant difference in adverse event.
Conclusion
In adult patients with out-of-hospital cardiac arrest requiring drug therapy, intraosseous route was not superior to intravenous route with respect to survival at day 30.
Reference
Keith Couper, Chen Ji, Charles D Deakin et al. A Randomized Trial of Drug Route in Out-of-Hospital Cardiac Arrest. N Engl J Med. 2024 Oct 31:10.1056/NEJMoa2407780. Online ahead of print.
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