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Retrospective Comparison of Upper and Lower Extremity Intraosseous Access During Out-of-Hospital Cardiac Arrest
Tanner Smida1, Remle Crowe2, Jeffrey Jarvis3,4
1West Virginia University MD/PhD Program, Morgantown, West Virginia.
Insights
Upper extremity intraosseous (IO) access in out-of-hospital cardiac arrest (OHCA) patients showed a small increase in the odds of return of spontaneous circulation (ROSC). This finding suggests upper extremity IO access may improve OHCA resuscitation outcomes.
Area of Science:
- Emergency Medicine
- Resuscitation Science
- Prehospital Care
Background:
- Intraosseous (IO) access is a critical resuscitation technique for out-of-hospital cardiac arrest (OHCA).
- The anatomical site of IO access may influence patient outcomes due to proximity to the heart and varying flow rates.
Purpose of the Study:
- To compare the outcomes of OHCA patients receiving upper versus lower extremity IO access during resuscitation.
- To identify if the anatomical site of IO access impacts key resuscitation metrics.
Main Methods:
- Retrospective analysis of the ESO Data Collaborative dataset.
- Inclusion of adult OHCA patients with successful upper or lower extremity IO access.
- Exclusion of patients with prior IV access or Do Not Resuscitate orders.
- Multivariable logistic regression analysis adjusting for numerous covariates to compare outcomes.
Main Results:
- 155,884 patients were included; 24% received upper extremity IO access.
- Upper extremity IO access was associated with significantly greater adjusted odds of return of spontaneous circulation (ROSC).
- Secondary analyses indicated upper extremity access correlated with increased survival to discharge and survival to home.
Conclusions:
- Upper extremity IO access demonstrated a modest increase in the odds of ROSC compared to lower extremity access in OHCA patients.
- These findings support further prospective research into the optimal IO access site for OHCA resuscitation.
- The results suggest a potential benefit of upper extremity IO access in improving OHCA survival.
Objective:
Intraosseous (IO) access is frequently utilized during the resuscitation of out-of-hospital cardiac arrest (OHCA) patients. Due to proximity to the heart and differential flow rates, the anatomical site of IO access may impact patient outcomes. Using a large dataset, we aimed to compare the outcomes of OHCA patients who received upper or lower extremity IO access during resuscitation.
Methods:
The ESO Data Collaborative public use research datasets were used for this retrospective study. All adult (≥18 years of age) OHCA patients with successful IO access in an upper or lower extremity were evaluated for inclusion. Patients were excluded if they had intravenous (IV) access prior to IO access, or if they had a Do Not Resuscitate order documented. Our primary outcome was return of spontaneous circulation (ROSC). Secondary outcomes included survival to discharge and survival to discharge to home. Mixed-effects multivariable logistic regression models adjusted for age, sex, etiology, witnessed status, pre-first responder cardiopulmonary resuscitation (CPR), initial electrocardiogram (ECG) rhythm, location [private/residential, public, or assisted living/institutional], and response time in addition to the primary airway management strategy (endotracheal intubation, supraglottic device, surgical airway, no advanced airway) were used to compare the outcomes of patients with upper extremity IO access to the outcomes of patients with lower extremity IO access.
Results:
After application of exclusion criteria, 155,884 patients who received IO access during resuscitation remained (76% lower extremity, 24% upper extremity). Upper extremity IO access was associated with greater adjusted odds of ROSC (1.11 [1.08, 1.15]), and this finding was consistent across multiple patient subgroups. Secondary analyses suggested that upper extremity access was associated with increased survival to discharge (1.18 [1.00, 1.39]) and survival to discharge to home (1.23 [1.02, 1.48]) in comparison to lower extremity IO access.
Conclusion:
In this large prehospital dataset, upper extremity IO access was associated with a small increase in the odds of ROSC in comparison to lower extremity IO access. These data support the need for prospective investigation of the ideal IO access site during OHCA resuscitation.
