院外心脏骤停时的骨内或静脉血管通路
Intraosseous or Intravenous Vascular Access for Out-of-Hospital Cardiac Arrest.
作者信息
Vallentin Mikael F, Granfeldt Asger, Klitgaard Thomas L, Mikkelsen Søren, Folke Fredrik, Christensen Helle C, Povlsen Amalie L, Petersen Alberthe H, Winther Sofie, Frilund Lea W, Meilandt Carsten, Holmberg Mathias J, Winther Kristian B, Bach Allan, Dissing Thomas H, Terkelsen Christian J, Christensen Steffen, Kirkegaard Rasmussen Line, Mortensen Lone R, Loldrup Mads L, Elkmann Thomas, Nielsen Anders G, Runge Charlotte, Klæstrup Elise, Holm Jimmy H, Bak Mikkel, Nielsen Lars-Gustav R, Pedersen Mette, Kjærgaard-Andersen Gunhild, Hansen Peter M, Brøchner Anne C, Christensen Erika F, Nielsen Frederik M, Nissen Christian G, Bjørn Jeppe W, Burholt Peter, Obling Laust E R, Holle Sarah L D, Russell Lene, Alstrøm Henrik, Hestad Søren, Fogtmann Tanja H, Buciek Jens U H, Jakobsen Karina, Krag Mette, Sandgaard Michael, Sindberg Birthe, Andersen Lars W
机构信息
From Prehospital Emergency Medical Services, Central Denmark Region (M.F.V., A.L.P., A.H.P., S.W., L.W.F., C.M., K.B.W., A.B., T.H.D., L.K.R., L.R.M., M.L.L., T.E., A.G.N., C.R., L.W.A.), the Department of Clinical Medicine, Aarhus University (M.F.V., A.G., C.J.T., S.C., L.W.A.), and the Departments of Anesthesiology and Intensive Care (A.G., M.J.H., T.H.D., S.C., C.G.N., B.S., L.W.A.), Cardiology (C.J.T.), and Radiology (E.K.), Aarhus University Hospital, Aarhus, the Department of Anesthesiology and Intensive Care, Aalborg University Hospital (T.L.K., F.M.N.), the Center for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital (E.F.C.), and Emergency Medical Services, North Denmark Region (P.B.), Aalborg, the Prehospital Research Unit (S.M., P.M.H.) and Emergency Medical Services (J.H.H., M.B., L.-G.R.N., M.P., G.K.-A., P.M.H.), Region of Southern Denmark, the Department of Anesthesiology and Intensive Care, Odense University Hospital (J.H.H., M.B.), and the Department of Regional Health Research, University of Southern Denmark (A.C.B.), Odense, the Departments of Cardiology (F.F.) and of Anesthesiology and Intensive Care (L.R.), Copenhagen University Hospital, Gentofte Copenhagen University Hospital-Emergency Medical Services, Ballerup (F.F., J.W.B., H.A., S.H., T.H.F.), the Department of Clinical Medicine, University of Copenhagen (F.F., H.C.C., L.R., M.K.), and the Department of Cardiology, the Heart Center, Copenhagen University Hospital, Rigshospitalet (L.E.R.O., S.L.D.H.), Copenhagen, the Prehospital Center, Region Zealand, Næstved (H.C.C.), the Department of Anesthesiology and Intensive Care, Gødstrup Regional Hospital, Gødstrup (L.K.R.), the Department of Anesthesiology and Intensive Care, Randers Regional Hospital, Randers (L.R.M., T.E.), the Department of Anesthesiology and Intensive Care, Viborg Regional Hospital, Viborg (A.G.N.), the Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg (C.R.), the Department of Anesthesiology and Intensive Care, University Hospital of Southern Denmark, Esbjerg and Grindsted, Esbjerg (L.-G.R.N.), the Department of Anesthesiology and Intensive Care, University Hospital of Southern Denmark, Kolding (M.P., A.C.B.), the Department of Anesthesiology and Intensive Care, University Hospital of Southern Denmark, Aabenraa (G.K.-A.), the Department of Anesthesiology and Intensive Care, Svendborg Hospital, Svendborg (P.M.H.), the Department of Anesthesiology and Intensive Care, Copenhagen University Hospital, Herlev (H.A.), the Department of Anesthesiology and Intensive Care, Copenhagen University Hospital-North Zealand, Hillerød (S.H.), the Department of Anesthesiology and Intensive Care, Zealand University Hospital, Køge (J.U.H.B.), the Department of Anesthesiology and Intensive Care, Nykøbing Falster Hospital, Nykøbing Falster (K.J.), the Department of Anesthesiology and Intensive Care, Holbæk Hospital, Holbæk (M.K.), and the Department of Anesthesiology and Intensive Care, Slagelse Hospital, Slagelse (M.S.) - all in Denmark.
出版信息
N Engl J Med. 2025 Jan 23;392(4):349-360. doi: 10.1056/NEJMoa2407616. Epub 2024 Oct 31.
BACKGROUND
Out-of-hospital cardiac arrest is a leading cause of death worldwide. Establishing vascular access is critical for administering guideline-recommended drugs during cardiopulmonary resuscitation. Both the intraosseous route and the intravenous route are used routinely, but their comparative effectiveness remains unclear.
METHODS
We conducted a randomized clinical trial to compare the effectiveness of initial attempts at intraosseous or intravenous vascular access in adults who had nontraumatic out-of-hospital cardiac arrest. The primary outcome was a sustained return of spontaneous circulation. Key secondary outcomes were survival at 30 days and survival at 30 days with a favorable neurologic outcome, defined by a score of 0 to 3 on the modified Rankin scale (scores range from 0 to 6, with higher scores indicating greater disability).
RESULTS
Among 1506 patients who underwent randomization, 1479 were included in the primary analysis (731 in the intraosseous-access group and 748 in the intravenous-access group). The successful establishment of vascular access within two attempts occurred in 669 patients (92%) assigned to the intraosseous-access group and in 595 patients (80%) assigned to the intravenous-access group. Sustained return of spontaneous circulation occurred in 221 patients (30%) in the intraosseous-access group and in 214 patients (29%) in the intravenous-access group (risk ratio, 1.06; 95% confidence interval [CI], 0.90 to 1.24; P = 0.49). At 30 days, 85 patients (12%) in the intraosseous-access group and 75 patients (10%) in the intravenous-access group were alive (risk ratio, 1.16; 95% CI, 0.87 to 1.56); a favorable neurologic outcome at 30 days occurred in 67 patients (9%) and 59 patients (8%), respectively (risk ratio, 1.16; 95% CI, 0.83 to 1.62). Prespecified adverse events were uncommon.
CONCLUSIONS
There was no significant difference in sustained return of spontaneous circulation between initial intraosseous and intravenous vascular access in adults who had out-of-hospital cardiac arrest. (Funded by the Novo Nordisk Foundation and others; IVIO EU Clinical Trials Register number, 2022-500744-38-00; ClinicalTrials.gov number, NCT05205031.).
背景
院外心脏骤停是全球主要的死亡原因。在心肺复苏期间建立血管通路对于给予指南推荐的药物至关重要。骨髓内途径和静脉途径均常规使用，但其相对有效性仍不明确。
方法
我们进行了一项随机临床试验，比较在非创伤性院外心脏骤停的成人中初次尝试骨髓内或静脉血管通路的有效性。主要结局是自主循环持续恢复。关键次要结局是30天生存率以及30天生存且神经功能良好，神经功能良好定义为改良Rankin量表评分为0至3分（评分范围为0至6分，分数越高表明残疾程度越高）。
结果
在1506例接受随机分组的患者中，1479例纳入主要分析（骨髓内通路组731例，静脉通路组748例）。在分配至骨髓内通路组的患者中，669例（92%）在两次尝试内成功建立血管通路；在分配至静脉通路组的患者中，595例（80%）成功建立血管通路。骨髓内通路组221例患者（30%）实现自主循环持续恢复，静脉通路组214例患者（29%）实现自主循环持续恢复（风险比，1.06；95%置信区间[CI]，0.90至1.24；P = 0.49）。30天时，骨髓内通路组85例患者（12%）存活，静脉通路组75例患者（10%）存活（风险比，1.16；95% CI，0.87至1.56）；30天时神经功能良好分别发生在67例患者（9%）和59例患者（8%）中（风险比，1.16；95% CI，0.83至1.62）。预设的不良事件并不常见。
结论
在院外心脏骤停的成人中，初次骨髓内和静脉血管通路在自主循环持续恢复方面无显著差异。（由诺和诺德基金会等资助；IVIO欧盟临床试验注册号，2022 - 500744 - 38 - 00；ClinicalTrials.gov编号，NCT05205031。）
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