Intraosseous or Intravenous Vascular Access for Out-of-Hospital Cardiac Arrest

Mikael F. Vallentin; Asger Granfeldt; Thomas L. Klitgaard; Søren Mikkelsen; Fredrik Folke; Helle C. Christensen; Amalie L. Povlsen; Alberthe H. Petersen; Sofie Winther; Lea W. Frilund; Carsten Meilandt; Mathias J. Holmberg; Kristian B. Winther; Allan Bach; Thomas H. Dissing; Christian J. Terkelsen; Steffen Christensen; Line Kirkegaard Rasmussen; Lone R. Mortensen; Mads L. Loldrup; Thomas Elkmann; Anders G. Nielsen; Charlotte Runge; Elise Klæstrup; Jimmy H. Holm; Mikkel Bak; Lars Gustav R. Nielsen; Mette Pedersen; Gunhild Kjærgaard-Andersen; Peter M. Hansen; Anne C. Brøchner; Erika F. Christensen; Frederik M. Nielsen; Christian G. Nissen; Jeppe W. Bjørn; Peter Burholt; Laust E.R. Obling; Sarah L.D. Holle; Lene Russell; Henrik Alstrøm; Søren Hestad; Tanja H. Fogtmann; Jens U.H. Buciek; Karina Jakobsen; Mette Krag; Michael Sandgaard; Birthe Sindberg; Lars W. Andersen

doi:10.1056/NEJMoa2407616

Intraosseous or Intravenous Vascular Access for Out-of-Hospital Cardiac Arrest

Mikael F. Vallentin, Asger Granfeldt, Thomas L. Klitgaard, Søren Mikkelsen, Fredrik Folke, Helle C. Christensen, Amalie L. Povlsen, Alberthe H. Petersen, Sofie Winther, Lea W. Frilund, Carsten Meilandt, Mathias J. Holmberg, Kristian B. Winther, Allan Bach, Thomas H. Dissing, Christian J. Terkelsen, Steffen Christensen, Line Kirkegaard Rasmussen, Lone R. Mortensen, Mads L. LoldrupThomas Elkmann, Anders G. Nielsen, Charlotte Runge, Elise Klæstrup, Jimmy H. Holm, Mikkel Bak, Lars Gustav R. Nielsen, Mette Pedersen, Gunhild Kjærgaard-Andersen, Peter M. Hansen, Anne C. Brøchner, Erika F. Christensen, Frederik M. Nielsen, Christian G. Nissen, Jeppe W. Bjørn, Peter Burholt, Laust E.R. Obling, Sarah L.D. Holle, Lene Russell, Henrik Alstrøm, Søren Hestad, Tanja H. Fogtmann, Jens U.H. Buciek, Karina Jakobsen, Mette Krag, Michael Sandgaard, Birthe Sindberg, Lars W. Andersen

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

17 Citationer (Scopus)

Abstract

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).

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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.)

Originalsprog	Engelsk
Tidsskrift	The New England Journal of Medicine
Vol/bind	392
Udgave nummer	4
Sider (fra-til)	349-360
Antal sider	12
ISSN	0028-4793
DOI	https://doi.org/10.1056/NEJMoa2407616
Status	Udgivet - 2025

Bibliografisk note

Publisher Copyright:
Copyright © 2024 Massachusetts Medical Society.

Adgang til dokumentet

10.1056/NEJMoa2407616

Citationsformater

Vallentin, M. F., Granfeldt, A., Klitgaard, T. L., Mikkelsen, S., Folke, F., Christensen, H. C., Povlsen, A. L., Petersen, A. H., Winther, S., Frilund, L. W., Meilandt, C., Holmberg, M. J., Winther, K. B., Bach, A., Dissing, T. H., Terkelsen, C. J., Christensen, S., Kirkegaard Rasmussen, L., Mortensen, L. R., ... Andersen, L. W. (2025). Intraosseous or Intravenous Vascular Access for Out-of-Hospital Cardiac Arrest. The New England Journal of Medicine, 392(4), 349-360. https://doi.org/10.1056/NEJMoa2407616

Vallentin, MF, Granfeldt, A, Klitgaard, TL, Mikkelsen, S, Folke, F , Christensen, HC, Povlsen, AL, Petersen, AH, Winther, S, Frilund, LW, Meilandt, C, Holmberg, MJ, Winther, KB, Bach, A, Dissing, TH, Terkelsen, CJ, Christensen, S, Kirkegaard Rasmussen, L, Mortensen, LR, Loldrup, ML, Elkmann, T, Nielsen, AG, Runge, C, Klæstrup, E, Holm, JH, Bak, M, Nielsen, LGR, Pedersen, M, Kjærgaard-Andersen, G, Hansen, PM, Brøchner, AC, Christensen, EF, Nielsen, FM, Nissen, CG, Bjørn, JW, Burholt, P, Obling, LER, Holle, SLD, Russell, L, Alstrøm, H, Hestad, S, Fogtmann, TH, Buciek, JUH, Jakobsen, K, Krag, M, Sandgaard, M, Sindberg, B & Andersen, LW 2025, 'Intraosseous or Intravenous Vascular Access for Out-of-Hospital Cardiac Arrest', The New England Journal of Medicine, bind 392, nr. 4, s. 349-360. https://doi.org/10.1056/NEJMoa2407616

@article{4a8c869de3d64d10a4f477a11d30fae3,

title = "Intraosseous or Intravenous Vascular Access for Out-of-Hospital Cardiac Arrest",

abstract = "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.).",

author = "Vallentin, {Mikael F.} and Asger Granfeldt and Klitgaard, {Thomas L.} and S{\o}ren Mikkelsen and Fredrik Folke and Christensen, {Helle C.} and Povlsen, {Amalie L.} and Petersen, {Alberthe H.} and Sofie Winther and Frilund, {Lea W.} and Carsten Meilandt and Holmberg, {Mathias J.} and Winther, {Kristian B.} and Allan Bach and Dissing, {Thomas H.} and Terkelsen, {Christian J.} and Steffen Christensen and {Kirkegaard Rasmussen}, Line and Mortensen, {Lone R.} and Loldrup, {Mads L.} and Thomas Elkmann and Nielsen, {Anders G.} and Charlotte Runge and Elise Kl{\ae}strup and Holm, {Jimmy H.} and Mikkel Bak and Nielsen, {Lars Gustav R.} and Mette Pedersen and Gunhild Kj{\ae}rgaard-Andersen and Hansen, {Peter M.} and Br{\o}chner, {Anne C.} and Christensen, {Erika F.} and Nielsen, {Frederik M.} and Nissen, {Christian G.} and Bj{\o}rn, {Jeppe W.} and Peter Burholt and Obling, {Laust E.R.} and Holle, {Sarah L.D.} and Lene Russell and Henrik Alstr{\o}m and S{\o}ren Hestad and Fogtmann, {Tanja H.} and Buciek, {Jens U.H.} and Karina Jakobsen and Mette Krag and Michael Sandgaard and Birthe Sindberg and Andersen, {Lars W.}",

note = "Publisher Copyright: Copyright {\textcopyright} 2024 Massachusetts Medical Society.",

year = "2025",

doi = "10.1056/NEJMoa2407616",

language = "English",

volume = "392",

pages = "349--360",

journal = "The New England Journal of Medicine",

issn = "0028-4793",

publisher = "Massachusetts Medical Society",

number = "4",

}

TY - JOUR

T1 - Intraosseous or Intravenous Vascular Access for Out-of-Hospital Cardiac Arrest

AU - Vallentin, Mikael F.

AU - Granfeldt, Asger

AU - Klitgaard, Thomas L.

AU - Mikkelsen, Søren

AU - Folke, Fredrik

AU - Christensen, Helle C.

AU - Povlsen, Amalie L.

AU - Petersen, Alberthe H.

AU - Winther, Sofie

AU - Frilund, Lea W.

AU - Meilandt, Carsten

AU - Holmberg, Mathias J.

AU - Winther, Kristian B.

AU - Bach, Allan

AU - Dissing, Thomas H.

AU - Terkelsen, Christian J.

AU - Christensen, Steffen

AU - Kirkegaard Rasmussen, Line

AU - Mortensen, Lone R.

AU - Loldrup, Mads L.

AU - Elkmann, Thomas

AU - Nielsen, Anders G.

AU - Runge, Charlotte

AU - Klæstrup, Elise

AU - Holm, Jimmy H.

AU - Bak, Mikkel

AU - Nielsen, Lars Gustav R.

AU - Pedersen, Mette

AU - Kjærgaard-Andersen, Gunhild

AU - Hansen, Peter M.

AU - Brøchner, Anne C.

AU - Christensen, Erika F.

AU - Nielsen, Frederik M.

AU - Nissen, Christian G.

AU - Bjørn, Jeppe W.

AU - Burholt, Peter

AU - Obling, Laust E.R.

AU - Holle, Sarah L.D.

AU - Russell, Lene

AU - Alstrøm, Henrik

AU - Hestad, Søren

AU - Fogtmann, Tanja H.

AU - Buciek, Jens U.H.

AU - Jakobsen, Karina

AU - Krag, Mette

AU - Sandgaard, Michael

AU - Sindberg, Birthe

AU - Andersen, Lars W.

PY - 2025

Y1 - 2025

N2 - 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.).

AB - 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.).

U2 - 10.1056/NEJMoa2407616

DO - 10.1056/NEJMoa2407616

M3 - Journal article

C2 - 39480221

AN - SCOPUS:85214563180

SN - 0028-4793

VL - 392

SP - 349

EP - 360

JO - The New England Journal of Medicine

JF - The New England Journal of Medicine

IS - 4

ER -