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Related Concept Videos

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

386
Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
386
  1. Home
  3. Research Domains
  5. Law And Legal Studies
  7. International And Comparative Law
  9. Conflict Of Laws (incl. Private International Law)
  11. Intraosseous Versus Intravenous Vascular Access In Upper Extremity Among Adults With Out-of-hospital Cardiac Arrest: Cluster Randomised Clinical Trial (victor Trial).
  1. Home
  3. Research Domains
  5. Law And Legal Studies
  7. International And Comparative Law
  9. Conflict Of Laws (incl. Private International Law)
  11. Intraosseous Versus Intravenous Vascular Access In Upper Extremity Among Adults With Out-of-hospital Cardiac Arrest: Cluster Randomised Clinical Trial (victor Trial).

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Intraosseous versus intravenous vascular access in upper extremity among adults with out-of-hospital cardiac arrest: cluster randomised clinical trial (VICTOR trial).

Ying-Chih Ko1,2, Hao-Yang Lin2, Edward Pei-Chuan Huang2,3

  • 1Section of Emergency Medicine, Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan.

BMJ (Clinical Research Ed.)
|July 23, 2024

View abstract on PubMed

Summary
This summary is machine-generated.

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Intraosseous (IO) vascular access showed similar survival rates to intravenous (IV) access in out-of-hospital cardiac arrest patients. This VICTOR trial found no significant difference in survival or neurological outcomes between IO and IV routes.

Area of Science:

  • Emergency Medicine
  • Cardiology
  • Critical Care

Background:

  • Establishing vascular access is critical for administering medications and fluids during resuscitation of patients with out-of-hospital cardiac arrest (OHCA).
  • Both intraosseous (IO) and intravenous (IV) routes are used for vascular access in emergency settings, but their comparative effectiveness in OHCA is debated.

Purpose of the Study:

  • To compare the effectiveness of intraosseous (IO) versus intravenous (IV) vascular access in adult patients experiencing non-traumatic out-of-hospital cardiac arrest (OHCA).
  • To evaluate differences in survival to hospital discharge, return of spontaneous circulation, and neurological outcomes between IO and IV access.

Main Methods:

  • A cluster randomized controlled trial (VICTOR trial) involving emergency medical service agencies in Taipei City, Taiwan.
  • Biweekly randomized clusters of ambulance teams were assigned to establish either IO or IV access in adult OHCA patients (age 20-80 years).
  • Primary outcome was survival to hospital discharge; secondary outcomes included return of spontaneous circulation and favorable neurological outcomes.

    • Main Results:

    • Among 1732 analyzed patients, 10.7% in the IO group survived to discharge compared to 10.3% in the IV group (OR 1.04, 95% CI 0.76-1.42; P=0.81).
    • No significant differences were observed between IO and IV access for pre-hospital return of spontaneous circulation (OR 1.23), sustained return of spontaneous circulation (OR 0.92), or survival with favorable neurological outcomes (OR 1.17).

    Conclusions:

    • Initial attempts at vascular access via the intraosseous route did not yield different outcomes compared to intravenous access in adults with non-traumatic OHCA.
    • The study suggests that both IO and IV access are comparably effective in terms of survival and neurological outcomes for OHCA patients.