Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon.
Prehosp Emerg Care. 2024;28(6):761-770. doi: 10.1080/10903127.2023.2286621. Epub 2023 Dec 22.
The optimal initial vascular access strategy for out-of-hospital cardiac arrest (OHCA) remains unknown. Our objective was to evaluate the association between peripheral intravenous (PIV), tibial intraosseous (TIO), or humeral intraosseous (HIO) as first vascular attempt strategies and outcomes for patients suffering OHCA.
This was a secondary analysis of the Portland Cardiac Arrest Epidemiologic Registry, which included adult patients (≥18 years-old) with EMS-treated, non-traumatic OHCA from 2018-2021. The primary independent variable in our analysis was the initial vascular access strategy, defined as PIV, TIO, or HIO based on the first access attempt. The primary outcome for this study was the return of spontaneous circulation (ROSC) at emergency department (ED) arrival (a palpable pulse on arrival to the hospital). Secondary outcomes included survival to: admission, discharge, and discharge with a favorable outcome (Cerebral Perfusion Category score of ≤2). We conducted multivariable logistic regressions, adjusting for confounding variables and for clustering using a mixed-effects approach, with prespecified subgroup analyses by initial rhythm.
We included 2,993 patients with initial vascular access strategies of PIV (822 [27.5%]), TIO (1,171 [39.1%]), and HIO (1,000 [33.4%]). Multivariable analysis showed lower odds of ROSC at ED arrival (adjusted odds ratio [95% CI]) with TIO (0.79 [0.64-0.98]) or HIO (0.75 [0.60-0.93]) compared to a PIV-first strategy. These associations remained in stratified analyses for those with shockable initial rhythms (0.60 [0.41-0.88] and 0.53 [0.36-0.79]) but not in patients with asystole or pulseless electrical activity for TIO and HIO compared to PIV, respectively. There were no statistically significant differences in adjusted odds for survival to admission, discharge, or discharge with a favorable outcome for TIO or HIO compared to the PIV-first group in the overall analysis. Patients with shockable initial rhythms had lower adjusted odds of survival to discharge (0.63 [0.41-0.96] and 0.64 [0.41-0.99]) and to discharge with a favorable outcome (0.60 [0.39-0.93] and 0.64 [0.40-1.00]) for TIO and HIO compared to PIV, respectively.
TIO or HIO as first access strategies in OHCA were associated with lower odds of ROSC at ED arrival compared to PIV.
院外心脏骤停（OHCA）的最佳初始血管通路策略仍不清楚。我们的目的是评估外周静脉（PIV）、胫骨骨髓内（TIO）或肱骨髓内（HIO）作为首次血管尝试策略与 OHCA 患者结局之间的关系。
这是波特兰心脏骤停流行病学登记处的二次分析，纳入了 2018 年至 2021 年接受急救医疗服务（EMS）治疗、非创伤性 OHCA 的成年患者（≥18 岁）。我们分析中的主要自变量是初始血管通路策略，根据首次尝试的血管通路，定义为 PIV、TIO 或 HIO。本研究的主要结局是急诊部（ED）到达时自主循环恢复（ROSC）（到达医院时可触及脉搏）。次要结局包括：入院、出院和出院时预后良好（脑灌注分类评分≤2）。我们进行了多变量逻辑回归，调整了混杂变量，并使用混合效应方法进行了聚类调整，同时根据初始节律进行了预设的亚组分析。
我们纳入了 2993 例初始血管通路策略为 PIV（822 [27.5%]）、TIO（1171 [39.1%]）和 HIO（1000 [33.4%]）的患者。多变量分析显示，与 PIV 相比，TIO（0.79 [0.64-0.98]）或 HIO（0.75 [0.60-0.93]）的 ED 到达时 ROSC 可能性较低。这些关联在初始节律为可除颤的分层分析中仍然存在（0.60 [0.41-0.88]和 0.53 [0.36-0.79]），但 TIO 和 HIO 与 PIV 相比，在初始为心搏停止或无脉电活动的患者中不存在。与 PIV 相比，TIO 或 HIO 组在总体分析中，在调整入院、出院或出院时预后良好的可能性方面，与 TIO 或 HIO 相比，调整入院、出院或出院时预后良好的可能性无统计学差异。初始节律为可除颤的患者，与 PIV 相比，TIO 和 HIO 组的出院（0.63 [0.41-0.96]和 0.64 [0.41-0.99]）和出院时预后良好（0.60 [0.39-0.93]和 0.64 [0.40-1.00]）的可能性较低。
与 PIV 相比，OHCA 中 TIO 或 HIO 作为首次血管通路策略与 ED 到达时 ROSC 可能性较低相关。
