title: Intravenous vs. intraosseous access and return of spontaneous circulation during out of hospital cardiac arrest.
abstract: BACKGROUND
  Guidelines endorse intravenous (IV) and intraosseous (IO) medication administration for cardiac arrest treatment. Limited clinical evidence supports this recommendation. A multiagency, retrospective study was performed to determine the association between parenteral access type and return of spontaneous circulation (ROSC) in out of hospital cardiac arrest.
  
  
  METHODS
  This was a structured, retrospective chart review of emergency medical services (EMS) records from three agencies. Data was analyzed from adults who suffered OHCA and received epinephrine through EMS established IV or IO access during the 18-month study period. Per regional EMS protocols, choice of parenteral access type was at the provider's discretion. Non-inferiority analysis was performed comparing the association between first access type attempted and ROSC at time of emergency department arrival.
  
  
  RESULTS
  1310 subjects met inclusion criteria and were included in the analysis. Providers first attempted parenteral access via IV route in 788 (60.15%) subjects. Providers first attempted parenteral access via IO route in 552 (39.85%) subjects. Rates of ROSC at time of ED arrival were 19.67% when IV access was attempted first and 19.92% when IO access was attempted first. An IO first approach was non-inferior to an IV first approach based on the primary end point ROSC at time of emergency department arrival (p=0.01).
  
  
  CONCLUSIONS
  An IO first approach was non-inferior to an IV first approach based on the end point ROSC at time of emergency department arrival.
authors.affiliation: Department of Emergency Medicine, University at Buffalo, University Emergency Medicine Services, 462 Grider Street, Buffalo, NY 14215, USA; American Medical Response (AMR), 481 William L. Gaiter Pkwy, Buffalo, NY 14215, USA. Electronic address: bc34@buffalo.edu.
authors.forename: Brian
authors.initials: B
authors.lastname: Clemency
authors.affiliation: Department of Emergency Medicine, University at Buffalo, University Emergency Medicine Services, 462 Grider Street, Buffalo, NY 14215, USA. Electronic address: ktanaka_0123@hotmail.com.
authors.forename: Kaori
authors.initials: K
authors.lastname: Tanaka
authors.affiliation: Department of Emergency Medicine, University at Buffalo, University Emergency Medicine Services, 462 Grider Street, Buffalo, NY 14215, USA. Electronic address: paulmay@buffalo.edu.
authors.forename: Paul
authors.initials: P
authors.lastname: May
authors.affiliation: Department of Emergency Medicine, University at Buffalo, University Emergency Medicine Services, 462 Grider Street, Buffalo, NY 14215, USA. Electronic address: JohannaInnes@gmail.com.
authors.forename: Johanna
authors.initials: J
authors.lastname: Innes
authors.affiliation: Department of Emergency Medicine, University at Buffalo, University Emergency Medicine Services, 462 Grider Street, Buffalo, NY 14215, USA. Electronic address: vsarazagr@buffalo.edu.
authors.forename: Sara
authors.initials: S
authors.lastname: Zagroba
authors.affiliation: Department of Emergency Medicine, University at Buffalo, University Emergency Medicine Services, 462 Grider Street, Buffalo, NY 14215, USA. Electronic address: jblaszak@buffalo.edu.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Blaszak
authors.affiliation: Department of Emergency Medicine, University at Buffalo, University Emergency Medicine Services, 462 Grider Street, Buffalo, NY 14215, USA; Department of Exercise and Nutrition Sciences, University at Buffalo, 211 Kimball Tower, Buffalo, NY 14214-8028, USA. Electronic address: dhostler@buffalo.edu.
authors.forename: David
authors.initials: D
authors.lastname: Hostler
authors.affiliation: American Medical Response (AMR), 481 William L. Gaiter Pkwy, Buffalo, NY 14215, USA; Department of Emergency Medicine, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA. Electronic address: cooney@upstate.edu.
authors.forename: Derek
authors.initials: D
authors.lastname: Cooney
authors.affiliation: Department of Emergency Medicine, University at Buffalo, University Emergency Medicine Services, 462 Grider Street, Buffalo, NY 14215, USA. Electronic address: kmcgeedo@gmail.com.
authors.forename: Kevin
authors.initials: K
authors.lastname: McGee
authors.affiliation: Department of Emergency Medicine, University at Buffalo, University Emergency Medicine Services, 462 Grider Street, Buffalo, NY 14215, USA. Electronic address: HLindstrom@ecmc.edu.
authors.forename: Heather
authors.initials: H
authors.lastname: Lindstrom
mesh_terms: D002985:Clinical Protocols; D004837:Epinephrine / Q000008:administration & dosage*; D006801:Humans; D017148:Infusions, Intraosseous; D007262:Infusions, Intravenous; D058687:Out-of-Hospital Cardiac Arrest / Q000188:drug therapy* / Q000401:mortality; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
chemical_list: D014662:Vasoconstrictor Agents; D004837:Epinephrine
keywords: Cardiac arrest; Emergency medical services; Epinephrine; Intraosseous infusion; Out of hospital cardiac arrest; Vascular access device