The association of intraosseous vascular access and survival among pediatric patients with out-of-hospital cardiac arrest.
Resuscitation · 2021-08-10 · Observational study
Abstract
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.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Children · Intraosseous access · Intravenous access · Mortality & survival
Related articles
- Intraosseous vs Intravenous Access for Epinephrine in Pediatric Out-of-Hospital Cardiac Arrest. (JAMA Netw Open, 2025)
- Time on the scene and interventions are associated with improved survival in pediatric out-of-hospital cardiac arrest. (Resuscitation, 2015)
- Intraosseous versus Intravenous Access in Pediatric Out-of-Hospital Cardiac Arrest: A Meta-Analysis of Survival Outcomes. (Am J Ther, 2026)
- Pediatric out-of-hospital cardiopulmonary resuscitation by helicopter emergency medical service, does it has added value compared to regular emergency medical service? (Eur J Trauma Emerg Surg, 2018)
- Intravenous or Intraosseous Vascular Access in Cardiac Arrest: An Individual Participant Data Meta-Analysis. (Resuscitation, 2026)
- Intraosseous versus intravenous vascular access during out-of-hospital cardiac arrest: a systematic review and meta-analysis. (Proc (Bayl Univ Med Cent), 2026)