SAMU 93 - UF Recherche-Enseignement-Qualité Université Paris 13, Sorbonne Paris Cité, Inserm U942, Hôpital Avicenne, Bobigny, France.
Service Mobile d'Urgence et de Réanimation, Centre Hospitalier Delafontaine, Saint-Denis, France.
Int J Nurs Pract. 2024 Oct;30(5):e13244. doi: 10.1111/ijn.13244. Epub 2024 Feb 26.
Obtaining vascular access is crucial in critically ill patients. The EZ-IO® device is easy to use and has a high insertion success rate. Therefore, the use of intraosseous vascular access (IOVA) has gradually increased.
We aim to determine how IOVA was integrated into management of vascular access during out-of-hospital cardiac arrest (OHCA) resuscitation.
Analysing the data from the OHCA French registry for events occurring between 1 January 2013 and 15 March 2021, we studied: demography, circumstances of occurrence and management including vascular access, delays and evolution. The primary outcome was the rate of IOVA implantation.
Among the 7156 OHCA included in the registry, we analysed the 3964 (55%) who received cardiopulmonary resuscitation. The vascular access was peripheral in 3122 (79%) cases, intraosseous in 775 (20%) cases and central in 12 (<1%) cases. The use of IOVA has increased linearly (R = 0.61) during the 33 successive trimesters studied representing 7% of all vascular access in 2013 and 33% in 2021 (p = 0.001). It was significantly more frequent in traumatic cardiac arrest: 12% versus 5%; p < 0.0001. The first epinephrine bolus occurred significantly later in the IOVA group, at 6 (4-10) versus 5 (3-8) min; p < 0.0001. Survival rate in the IOVA group was significantly lower, at 1% versus 7%; p < 0.0001.
The insertion rate of IOVA significantly increased over the studied period, to reach 30% of all vascular access in the management OHCA patients. The place of the intraosseous route in the strategy of venous access during the management of prehospital cardiac arrest has yet to be determined.
在危重症患者中，获得血管通路至关重要。EZ-IO® 设备易于使用，且具有较高的插入成功率。因此，骨内血管通路（IOVA）的使用逐渐增加。
我们旨在确定在院外心脏骤停（OHCA）复苏期间，IOVA 如何整合到血管通路管理中。
通过分析 2013 年 1 月 1 日至 2021 年 3 月 15 日期间发生的 OHCA 法国登记处的数据，我们研究了以下内容：人口统计学、发生情况和管理，包括血管通路、延迟和演变。主要结局是 IOVA 植入率。
在登记处纳入的 7156 例 OHCA 中，我们分析了接受心肺复苏的 3964 例（55%）。血管通路外周为 3122 例（79%），骨内为 775 例（20%），中心为 12 例（<1%）。在研究的 33 个连续季度中，IOVA 的使用呈线性增加（R=0.61），代表 2013 年所有血管通路的 7%和 2021 年的 33%（p=0.001）。在创伤性心脏骤停中，其使用率明显更高，分别为 12%和 5%；p<0.0001。在 IOVA 组，首次肾上腺素推注的时间明显延迟，为 6（4-10）min 与 5（3-8）min；p<0.0001。在 IOVA 组，生存率明显更低，分别为 1%和 7%；p<0.0001。
在研究期间，IOVA 的插入率显著增加，达到 OHCA 患者所有血管通路的 30%。在管理院前心脏骤停时，骨内途径在静脉通路策略中的地位仍有待确定。
