Researchers compared intraosseous and intravenous drug administration strategies during out-of-hospital cardiac arrest, finding no significant difference in 30-day survival rates between the two approaches.
A report published in The New England Journal of Medicine detailed findings from the PARAMEDIC-3 trial involving 6,082 patients who experienced out-of-hospital cardiac arrest. Researchers compared survival between intraosseous (IO) and intravenous (IV) drug administration strategies. Conducted across 11 emergency medical systems in the United Kingdom, the trial evaluated 30-day survival as its primary outcome.
Among the 3,030 patients in the IO group, 137 (4.5%) were alive at 30 days, compared to 155 of 3,034 patients (5.1%) in the IV group (adjusted odds ratio [aOR] = 0.94; 95% confidence interval [CI] = 0.68–1.32; P = .74). The study authors concluded that vascular access route did not significantly impact survival outcomes.
Secondary outcomes included the return of spontaneous circulation (ROSC) and favorable neurological function at discharge, defined by a score of three or less on the modified Rankin scale. ROSC occurred in 36.0% of those in the IO group compared to 39.1% in the IV group (aOR = 0.86; 95% CI = 0.76–0.97). Favorable neurological outcomes were observed in 2.7% of patients in the IO group and 2.8% in the IV group (aOR = 0.91; 95% CI = 0.57–1.47).
"The use of an [IO]-first vascular access strategy did not result in higher 30-day survival than an [IV]-first strategy," wrote first study author Keith Couper, PhD, of the Warwick Medical School, Clinical Trials Unit, University of Warwick, and colleagues.
No adjustments for multiplicity were made in the analysis.
The findings underscore the ongoing challenge of optimizing drug administration during out-of-hospital cardiac arrest. As noted by the study investigators, further research may be required to explore alternative strategies that could improve survival and neurological outcomes.
The trial was funded by the National Institute for Health and Care Research and supported by additional grants, including from the National Institutes of Health.
