High-stakes medical emergency scene where paramedics are performing intraosseous vascular access on a patient during cardiac arrest in the field, with tension-filled expressions and high-tech equipment. The image captures the urgency and precision required in out-of-hospital settings.
During cardiac arrest emergencies, rapid vascular access is critical. Medical professionals have long debated the best method to establish access: intraosseous or intravenous routes. A recent study, the VICTOR trial, compared these two approaches in out-of-hospital cardiac arrests.
Study Design The trial involved 1,732 adults across four advanced life support ambulance teams in Taipei, Taiwan. Patients were randomized biweekly to either intraosseous (IO) or intravenous (IV) access during resuscitation. Both groups showed a similar age distribution and ratio of male participants.
Outcome Measures Primary outcomes included survival to hospital discharge. Secondary measures included pre-hospital return of spontaneous circulation and favorable neurological outcomes at discharge. The trial’s lead researcher noted: “While the intraosseous route may offer faster access, our findings suggest that survival rates between IO and IV are comparable.”
No Significant Differences The results were striking in their uniformity across both access methods. In the IO group, 79 (10.7%) patients survived to discharge, closely mirroring the 102 (10.3%) survivors in the IV group. A researcher from the trial commented: “These findings challenge the assumption that intraosseous access provides better outcomes in emergency settings.”
When asked about the implications of the trial, one of the co-authors emphasized, “Medical teams should consider both options equally, as our study shows no clear benefit of one over the other.”
Implications for Emergency Care Although both methods are deemed acceptable, the choice between intraosseous and intravenous routes should depend on the specific context and team familiarity. One researcher added, “Our results highlight the importance of flexibility and the need for tailored interventions during cardiac arrest situations.”
Citation:
Ko YC, Lin HY, Huang EP, Lee AF, Hsieh MJ, Yang CW, et al. Intraosseous versus intravenous vascular access in upper extremity among adults with out-of-hospital cardiac arrest: cluster randomised clinical trial (VICTOR trial). BMJ. 2024 Jul 23;386. doi: 10.1136/bmj-2024-079878.
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