Fire Department, Taoyuan City Government, Taiwan.
Department of Emergency Medicine, National Taiwan University Hospital, Yun-Lin Branch, Taiwan.
Am J Emerg Med. 2023 May;67:63-69. doi: 10.1016/j.ajem.2023.02.003. Epub 2023 Feb 7.
The benefits and risks of the intraosseous (IO) route for vascular access in patients with out-of-hospital cardiac arrest (OHCA) remain controversial. This study compares the success rates of establishing the access route, epinephrine administration rates, and time-to-epinephrine between adult patients with OHCA with IO access and those with intravenous (IV) access established by paramedics in the prehospital setting.
This was a retrospective study conducted by the San-Min station of Taoyuan Fire Department. Data for IV access were collected between January 1, 2020, and December 31, 2020. Data for IO access were collected between January 1, 2021, and March 10, 2021. Inclusion criteria were adult patients with OHCA who received on-scene resuscitation attempts and in whom either IV or IO route access was established by paramedics. Exclusion criteria were missing data, return of spontaneous circulation before establishing vascular access, cardiac arrest en route to hospital, patients not resuscitated, and OHCA unidentified by the dispatcher. Exposure was defined as IV route vs. IO route (EZ-IO®). The outcome measurements were per-patient based success rates of route establishment (successes/attempts), administration rates of epinephrine (epinephrine administered per case/enrolled OHCAs), and odds ratios of IV versus IO on epinephrine administration. We used nonparametric Mann-Whitney rank sum tests for the analysis in continuous variables and Fisher's exact tests for the analysis of categorical variables and the outcomes. Firth logistic regression method was used for sparse data. Factors associated with epinephrine administration other than vascular access were also analyzed. Time-to-epinephrine (defined as time from paramedic arrival to epinephrine injection) was reviewed and calculated by two independent observers and the Kaplan-Meier method was used to compare the two access routes.
A total of 112 adult patients were enrolled in the analysis, including 71 men and 41 women, with an average age of 67 years. There were 90 IV access cases and 22 IO access cases. The groups were compared for median success rates of route establishment (33% vs. 100%, P < 0.001) and administration rates of epinephrine (52% vs. 100%, P < 0.001). The adjusted odds ratio of IO versus IV was 32.445, 95% confidence interval (CI) of 1.844-570.861. Time-to-epinephrine was significantly shorter in the cumulative time-event analysis by the Kaplan-Meier method (P < 0.001).
The IO route was significantly associated with higher success rates of route establishment, epinephrine administration, and shorter time-to-epinephrine in the prehospital resuscitation of adult patients with OHCA.
在院外心脏骤停（OHCA）患者中，经皮骨内（IO）途径进行血管通路建立的获益和风险仍存在争议。本研究比较了在院前环境中，使用 IO 通路建立血管通路的 OHCA 成年患者与使用急救人员建立静脉（IV）通路的患者之间，建立通路的成功率、肾上腺素给药率和肾上腺素给药时间。
这是桃园消防局三民站进行的一项回顾性研究。IV 通路的数据收集时间为 2020 年 1 月 1 日至 12 月 31 日。IO 通路的数据收集时间为 2021 年 1 月 1 日至 2021 年 3 月 10 日。纳入标准为接受现场复苏尝试的 OHCA 成年患者，且急救人员通过 IV 或 IO 途径建立了血管通路。排除标准为数据缺失、建立血管通路前自主循环恢复、在送往医院途中发生心脏骤停、未进行复苏和调度员未识别 OHCA。暴露定义为 IV 通路与 IO 通路（EZ-IO®）。主要测量指标为每例患者的通路建立成功率（成功例数/尝试例数）、肾上腺素给药率（每例病例/纳入的 OHCA 中给予的肾上腺素）和肾上腺素给药时 IV 与 IO 的比值。我们使用非参数 Mann-Whitney 秩和检验分析连续变量，使用 Fisher 确切检验分析分类变量和结局。对于稀疏数据，使用 Firth 逻辑回归方法。还分析了血管通路以外与肾上腺素给药相关的其他因素。时间-肾上腺素（定义为急救人员到达至肾上腺素注射的时间）由两名独立观察员进行回顾和计算，并使用 Kaplan-Meier 方法比较两种通路。
共纳入 112 例成年患者，其中男性 71 例，女性 41 例，平均年龄为 67 岁。IV 通路 90 例，IO 通路 22 例。比较两组通路建立的成功率（33%比 100%，P<0.001）和肾上腺素给药率（52%比 100%，P<0.001）。IO 与 IV 的调整比值比为 32.445，95%置信区间（CI）为 1.844-570.861。Kaplan-Meier 方法的累积时间事件分析显示，肾上腺素给药时间明显更短（P<0.001）。
在 OHCA 成年患者的院前复苏中，IO 通路与更高的通路建立成功率、肾上腺素给药率和更短的肾上腺素给药时间显著相关。
