Intravenous Vs. Intraosseous Vascular Access During Out-of-Hospital

Conditions

Cardiac Arrest

Brief summary

The Intravenous vs. Intraosseous Vascular Access During Out-of-Hospital Cardiac Arrest (IVIO)-trial is an investigator-initiated, randomized, parallel group, patient and outcome assessor-blinded, superiority trial of intravenous vs. intraosseous vascular access during adult out-of-hospital cardiac arrest. The intraosseous group will be further randomized to humeral vs. tibial access. The trial will be conducted in the Central Denmark Region. The primary outcome will be sustained return of spontaneous circulation, and 762 patients will be included. Key secondary outcomes include survival at 30 days and survival at 30 days with a favorable neurological outcome.

Vallentin MF, Holmberg MJ, Granfeldt A, Klitgaard TL, Mikkelsen S, Folke F, Christensen HC, Povlsen AL, Petersen AH, Winther S, Frilund LW, Meilandt C, Winther KB, Bach A, Dissing TH, Terkelsen CJ, Christensen S, Rasmussen LK, Mortensen LR, Loldrup ML, Elkmann T, Nielsen AG, Runge C, Klæstrup E, Holm JH, Bak M, Nielsen LR, Pedersen M, Kjærgaard-Andersen G, Hansen PM, Brøchner AC, Christensen EF, Nielsen FM, Nissen CG, Bjørn JW, Burholt P, Obling LER, Holle SLD, Russell L, Alstrøm H, Hestad S, Fogtmann TH, Hove Buciek JU, Jakobsen K, Krag M, Sandgaard M, Sindberg B, Andersen LW.

2025-05-17

10.1016/j.resuscitation.2025.110634

Intraosseous or Intravenous Vascular Access for Out-of-Hospital Cardiac Arrest

Mikael Fink Vallentin, Asger Granfeldt, Thomas Klitgaard, Søren Mikkelsen, Fredrik Folke et al. (48 authors)

New England Journal of Medicine2024-10-3162 citations

10.1056/nejmoa2407616

Route of drug administration in out-of-hospital cardiac arrest: A protocol for a randomised controlled trial (PARAMEDIC-3)

Keith Couper, Chen Ji, Ranjit Lall, Charles D. Deakin, Rachael Fothergill et al. (42 authors)

Resuscitation Plus2023-12-309 citations

10.1016/j.resplu.2023.100544

Papers published before 2007-09-01 may not appear yet. Historical indexing is in progress.

Interventions

DEVICEIntraosseous access

Needle placed in the bone marrow.

DEVICEIntravenous

Needle placed in a vein.

Study design

Allocation

RANDOMIZED

Intervention model

PARALLEL

Primary purpose

TREATMENT

Masking

DOUBLE (Subject, Outcomes Assessor)

Eligibility

Sex/Gender

ALL

Age

18 Years to No maximum

Healthy volunteers

No

Inclusion criteria

1. Out-of-hospital cardiac arrest 2. Age ≥ 18 years 3. Indication for intravenous or intraosseous vascular access during cardiac arrest

Exclusion criteria

1. Blunt or penetrating traumatic cardiac arrest 2. Prior enrollment in the trial 3. Intravenous or intraosseous vascular access already in place and working when the first trial-participating unit arrives on site

Design outcomes

Primary

Measure	Time frame	Description
Sustained return of spontaneous circulation	Before or after hospital arrival (up to 2 hours after the cardiac arrest)	Palpable pulses or other signs of circulation without a need for chest compressions lasting at least 20 minutes

Secondary

Measure	Time frame	Description
Survival	30 days after the cardiac arrest	—
Favorable neurological outcome	30 days after the cardiac arrest	Neurological outcome will be assessed with the modified Rankin Scale (mRS) which is a scale from 0 to 6 assessing neurological/functional outcomes after brain damage with higher scores indicating worse neurological/functional outcomes. The scale will will be dichotomized as favorable (mRS 0-3) vs. unfavorable (mRS 4-6).

Countries

Denmark

Outcome results

None listed