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.).

中文翻译：

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用于院外心脏骤停的骨内或静脉血管通路。


背景 院外心脏骤停是全世界死亡的主要原因。建立血管通路对于在心肺复苏期间使用指南推荐的药物至关重要。骨内途径和静脉途径都是常规使用，但它们的比较效果仍不清楚。方法 我们进行了一项随机临床试验，以比较在非创伤性院外心脏骤停的成人中首次尝试骨内或静脉血管通路的有效性。主要结局是自主循环的持续恢复。关键的次要结局是 30 天生存率和 30 天生存率，神经系统结局良好，定义为改良 Rankin 量表评分为 0 至 3 分（评分范围为 0 至 6，评分越高表示残疾程度越高）。结果 在接受随机分组的 1506 例患者中，1479 例被纳入初步分析 （骨内通路组 731 例，静脉通路组 748 例）。骨内通路组的 669 例患者 （92%） 和静脉通路组的 595 例患者 （80%） 在两次尝试内成功建立血管通路。骨内通路组 221 例患者 （30%） 和静脉通路组 214 例患者 （29%） 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，骨内通路组有 85 例患者 （12%） 存活，静脉通路组有 75 例患者 （10%） 存活（风险比，1.16;95% CI，0.87 至 1.56）;67 例患者 （9%） 和 59 例患者 （8%） 在 30 天时出现良好的神经系统结局 （风险比，1.16;95% CI，0.83 至 1。62）. 预先指定的不良事件并不常见。结论 在院外心脏骤停的成人中，初始骨内和静脉血管通路之间的自主循环持续恢复没有显著差异。（由 Novo Nordisk Foundation 和其他机构资助;IVIO 欧盟临床试验注册号，2022-500744-38-00;ClinicalTrials.gov 号，NCT05205031.）。