Brebner Callahan, Asamoah-Boaheng Michael, Zaidel Bianca, Yap Justin, Scheuermeyer Frank, Mok Valerie, Hutton Jacob, Meckler Garth, Schlamp Robert, Christenson Jim, Grunau Brian
British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada.
British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada; Centre for Advancing Health Outcomes, St. Paul's Hospital, Vancouver, B.C., Canada.
Resuscitation. 2024 Sep;202:110360. doi: 10.1016/j.resuscitation.2024.110360. Epub 2024 Aug 16.
While intravenous (IV) vascular access for out-of-hospital cardiac arrest (OHCA) resuscitation is standard, humeral-intraosseous (IO) access is commonly used, despite few supporting data. We investigated the association between IV vs. humeral-IO and outcomes.
We utilized BC Cardiac Arrest Registry data, including adult OHCA where the first-attempted intra-arrest vascular access route performed by advanced life support (ALS)-trained paramedics was IV or humeral-IO. We fit a propensity-score adjusted model with inverse probability treatment weighting to estimate the association between IV vs. humeral-IO routes and favorable neurological outcomes (CPC 1-2) and survival at hospital discharge. We repeated models within subgroups defined by initial cardiac rhythm.
We included 2,112 cases; the first-attempted route was IV (n = 1,575) or humeral-IO (n = 537). Time intervals from ALS-paramedic on-scene arrival to vascular access (6.6 vs. 6.9 min) and epinephrine administration (9.0 vs. 9.3 min) were similar between IV and IO groups, respectively. Among IV and humeral-IO groups, 98 (6.2%) and 20 (3.7%) had favorable neurological outcomes. Compared to humeral-IO, an IV-first approach was associated with improved hospital-discharge favorable neurological outcomes (AOR 1.7; 95% CI 1.1-2.7) and survival (AOR 1.5; 95% CI 1.0-2.3). Among shockable rhythm cases, an IV-first approach was associated with improved favorable neurological outcomes (AOR 4.2; 95% CI 2.1-8.2), but not among non-shockable rhythm cases (AOR 0.73; 95% CI 0.39-1.4).
An IV-first approach, compared to humeral-IO, for intra-arrest resuscitation was associated with an improved odds of favorable neurological outcomes and survival to hospital discharge. This association was seen among an initial shockable rhythm, but not non-shockable rhythm, subgroups.
虽然院外心脏骤停（OHCA）复苏时静脉（IV）血管通路是标准做法，但尽管支持数据很少，肱骨骨髓腔内（IO）通路仍被广泛使用。我们研究了IV与肱骨IO通路及预后之间的关联。
我们利用了卑诗省心脏骤停登记数据，包括成年OHCA患者，其中由接受过高级生命支持（ALS）培训的护理人员首次尝试的心脏骤停期间血管通路途径为IV或肱骨IO。我们采用倾向评分调整模型及逆概率处理加权法来估计IV与肱骨IO通路途径与良好神经功能预后（脑功能分级1 - 2级）及出院生存率之间的关联。我们在按初始心律定义的亚组内重复了模型分析。
我们纳入了2112例病例；首次尝试的途径为IV（n = 1575）或肱骨IO（n = 537）。IV组和IO组从ALS护理人员到达现场到建立血管通路的时间间隔（6.6对6.9分钟）以及给予肾上腺素的时间间隔（9.0对9.3分钟）分别相似。在IV组和肱骨IO组中，分别有98例（6.2%）和20例（3.7%）有良好神经功能预后。与肱骨IO相比，先采用IV途径与出院时改善的良好神经功能预后（调整后比值比1.7；95%置信区间1.1 - 2.7）和生存率（调整后比值比1.5；95%置信区间1.0 - 2.3）相关。在可电击心律病例中，先采用IV途径与改善的良好神经功能预后相关（调整后比值比4.2；95%置信区间2.1 - 8.2），但在不可电击心律病例中则不然（调整后比值比0.73；95%置信区间0.39 - 1.4）。
与肱骨IO相比，心脏骤停期间复苏先采用IV途径与良好神经功能预后及出院生存率提高的几率相关。这种关联在初始可电击心律亚组中可见，但在不可电击心律亚组中未见。
