• 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, Kirkegaard RasmussenLineLFrom 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, Aarhu, 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, and Lars W Andersen.
• 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.
• N. Engl. J. Med. 2024 Oct 31.

BackgroundOut-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.MethodsWe 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).ResultsAmong 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.ConclusionsThere 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.).Copyright © 2024 Massachusetts Medical Society.

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