دورية أكاديمية
Clinical evaluation of intravenous alone versus intravenous or intraosseous access for treatment of out-of-hospital cardiac arrest.
| العنوان: | Clinical evaluation of intravenous alone versus intravenous or intraosseous access for treatment of out-of-hospital cardiac arrest. |
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| المؤلفون: | Tan BKK; Department of Emergency Medicine, Singapore General Hospital, Outram Road, 169608, Singapore., Chin YX; Department of Anaesthesiology, Singapore General Hospital, Outram Road, 169608, Singapore., Koh ZX; Department of Emergency Medicine, Singapore General Hospital, Outram Road, 169608, Singapore., Md Said NAZB; Medical Department, Singapore Civil Defence Force, 91 Ubi Avenue 4, 408827, Singapore., Rahmat M; Medical Department, Singapore Civil Defence Force, 91 Ubi Avenue 4, 408827, Singapore., Fook-Chong S; Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore., Ng YY; Home Team Medical Services Division, Ministry of Home Affairs, 28 Irrawaddy Road, 329560, Singapore; Emergency Department, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, 308433, Singapore., Ong MEH; Department of Emergency Medicine, Singapore General Hospital, Outram Road, 169608, Singapore; Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore. Electronic address: marcus.ong.e.h@singhealth.com.sg. |
| المصدر: | Resuscitation [Resuscitation] 2021 Feb; Vol. 159, pp. 129-136. Date of Electronic Publication: 2020 Nov 19. |
| نوع المنشور: | Journal Article; Randomized Controlled Trial |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier/north-Holland Biomedical Press Country of Publication: Ireland NLM ID: 0332173 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-1570 (Electronic) Linking ISSN: 03009572 NLM ISO Abbreviation: Resuscitation Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: Limerick : Elsevier/north-Holland Biomedical Press Original Publication: London, Middlesex Pub. Co. |
| مواضيع طبية MeSH: | Cardiopulmonary Resuscitation* , Emergency Medical Services* , Out-of-Hospital Cardiac Arrest*/drug therapy, Epinephrine/therapeutic use ; Humans ; Infusions, Intraosseous ; Prospective Studies |
| مستخلص: | Objective: Obtaining vascular access during out-of-hospital cardiac arrest (OHCA) is challenging. The aim of this study was to determine if using intraosseous (IO) access when intravenous (IV) access fails improves outcomes. Methods: This was a prospective, parallel-group, cluster-randomised study that compared 'IV only' against 'IV + IO' in OHCA patients, where if 2 IV attempts failed or took more than 90 s, paramedics had 2 further attempts of IO. Primary outcome was any return of spontaneous circulation (ROSC). Secondary outcomes were insertion success rate, adrenaline administration, time to adrenaline and survival outcome. Results: A total of 1007 patients were included in the analysis. An Intention To Treat analysis showed a significant difference in success rates of obtaining vascular access in the IV + IO arm compared to the IV arm (76.6% vs 61.1% p = 0.001). There were significantly more patients in the IV + IO arm than the IV arm being administered prehospital adrenaline (71.3% vs 55.4% p = 0.001). The IV + IO arm also received adrenaline faster compared to the IV arm in terms of median time from emergency call to adrenaline (23 min vs 25 min p = 0.001). There was no significant difference in ROSC (adjusted OR 0.99 95%CI: 0.75-1.29), survival to discharge or survival with CPC 2 or better in both groups. A Per Protocol analysis also showed there was higher success in obtaining vascular access in the IV + IO arm, but ROSC and survival outcomes were not statistically different. Conclusion: Using IO when IV failed led to a higher rate of vascular access, prehospital adrenaline administration and faster adrenaline administration. However, it was not associated with higher ROSC, survival to discharge, or good neurological outcome. (Copyright © 2020 Elsevier B.V. All rights reserved.) |
| فهرسة مساهمة: | Keywords: Adrenaline; EMS; Intraosseous; Intravenous; Out-of-hospital cardiac arrest; Prehospital; Resuscitation |
| المشرفين على المادة: | YKH834O4BH (Epinephrine) |
| تواريخ الأحداث: | Date Created: 20201122 Date Completed: 20210621 Latest Revision: 20210621 |
| رمز التحديث: | 20231215 |
| DOI: | 10.1016/j.resuscitation.2020.11.019 |
| PMID: | 33221362 |
| قاعدة البيانات: | MEDLINE |
Full Text via ClinicalKey 
Full Text Finder | تدمد: | 1873-1570 |
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| DOI: | 10.1016/j.resuscitation.2020.11.019 |