The association of intraosseous vascular access and survival among pediatric patients with out-of-hospital cardiac arrest,Resuscitation

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The association of intraosseous vascular access and survival among pediatric patients with out-of-hospital cardiac arrest
Resuscitation ( IF 6.5 ) Pub Date : 2021-08-10 , DOI: 10.1016/j.resuscitation.2021.08.005
Floyd Besserer ₁ , Takahisa Kawano ₂ , Justin Dirk ₃ , Garth Meckler ₄ , Janice A Tijssen ₅ , Allan DeCaen ₆ , Frank Scheuermeyer ₇ , Suzanne Beno ₈ , Jim Christenson ₇ , Brian Grunau ₉ ,

Affiliation

Department of Emergency Medicine, University of British Columbia, Canada; BC Emergency Health Services, British Columbia, Canada; Canadian Resuscitation Outcomes Consortium, Canada.
Canadian Resuscitation Outcomes Consortium, Canada; Department of Emergency Medicine, University of Fukui Hospital, Fukui Prefecture, Japan.
School of Medicine, Queen's University, Ontario, Canada.
Department of Emergency Medicine, University of British Columbia, Canada; BC Emergency Health Services, British Columbia, Canada; Canadian Resuscitation Outcomes Consortium, Canada; Department of Pediatrics, University of British Columbia, Canada.
Canadian Resuscitation Outcomes Consortium, Canada; Department of Paediatrics, Western University, Canada.
Canadian Resuscitation Outcomes Consortium, Canada; Department of Paediatrics, University of Alberta, Canada.
Department of Emergency Medicine, University of British Columbia, Canada; Canadian Resuscitation Outcomes Consortium, Canada; Centre for Health Evaluation and Outcome Sciences, Canada.
Department of Paediatrics, University of Toronto, Canada.
Department of Emergency Medicine, University of British Columbia, Canada; BC Emergency Health Services, British Columbia, Canada; Canadian Resuscitation Outcomes Consortium, Canada; Centre for Health Evaluation and Outcome Sciences, Canada.

Introduction

In pediatric out-of-hospital cardiac arrest (OHCA) the effect of intraosseous (IO) or intravenous (IV) access on outcomes is unclear.

Methods

We analyzed prospectively collected data of non-traumatic OHCA in the Resuscitation Outcomes Consortium registry from 2011 to 2015. We included EMS-treated patients ≤17 years of age, classified patients based on vascular access routes, and calculated success rates of IO and IV attempts. After excluding patients with obvious non-cardiac etiologies and those with unsuccessful vascular access or multiple routes, we fit a logistic regression model to evaluate the association of IO vascular access (reference IV access) with the primary outcome of survival, using multiple imputation to address missing data. We analyzed a subgroup of patients at least 2 years of age.

Results

There were 1549 non-traumatic OHCA: 895 (57.8%) patients had an IO line attempted with 822 (91.8%) successful; 488 (31.5%) had an IV line attempted with 345 (70.7%) successful (difference 21%, 95% CI 17 to 26%). Of the 761 patients included in our logistic regression, 601 received IO (30 [5.2%] survived) and 160 received IV (40 [25%] survived) vascular access. Intraosseous access was associated with a decreased probability of survival (adjusted OR 0.46; 95% CI 0.21–0.98). Patients at least 2 years of age showed a similar association (adjusted OR 0.36; CI 0.15–0.86).

Conclusions

Intraosseous access was associated with decreased survival among pediatric non-traumatic OHCA. These results are exploratory and support the need for further study to evaluate the effect of intravascular access method on outcomes.

中文翻译：

院外心脏骤停儿科患者骨内血管通路与生存的相关性

介绍

在儿科院外心脏骤停 (OHCA) 中，骨内 (IO) 或静脉 (IV) 通路对结果的影响尚不清楚。

方法

我们分析了 2011 年至 2015 年复苏结果联盟登记处前瞻性收集的非创伤性 OHCA 数据。我们纳入了 17 岁以下接受 EMS 治疗的患者，根据血管通路对患者进行分类，并计算 IO 和 IV 尝试的成功率. 在排除明显非心脏病因的患者和血管通路不成功或多条通路的患者后，我们拟合逻辑回归模型来评估 IO 血管通路（参考 IV 通路）与生存主要结果的关联，使用多重插补来解决缺失数据。我们分析了至少 2 岁的患者亚组。

结果

有 1549 名非创伤性 OHCA：895 名 (57.8%) 患者尝试了 IO 线，其中 822 名 (91.8%) 成功；488 人 (31.5%) 尝试了静脉输液管，其中 345 人 (70.7%) 成功（差异 21%，95% CI 17 至 26%）。在我们的逻辑回归中包括的 761 名患者中，601 名接受 IO（30 [5.2%] 存活）和 160 名接受 IV（40 [25%] 存活）血管通路。骨内通路与生存概率降低相关（调整后 OR 0.46；95% CI 0.21–0.98）。至少 2 岁的患者表现出类似的关联（调整后的 OR 0.36；CI 0.15-0.86）。