Abstract:
Objective: The establishment of intraosseous (IO) access in patients with out-of-hospital cardiac arrest (OHCA) enables reliable vasopressor administration. However, no studies have examined the association between IO access and vasopressor administration in a nationwide prehospital setting. We aimed to examine the association between IO access and vasopressor administration in patients with OHCA using a nationwide database.
Methods: This retrospective cohort study used data from the Japanese Society for Aeromedical Services Registry (JSAS-R) between April 2020 and March 2023. The primary outcome was vasopressor administration before hospital arrival. Secondary outcomes included in-hospital mortality, length of hospital stay, doctor contact-to-hospital arrival time, and return of spontaneous circulation (ROSC) on hospital arrival. The association between IO access establishment and clinical outcomes was examined using multivariate logistic regression with multiple imputation.
Results: Among 3,264 patients with OHCA, 321 (9.8%) received IO access (IO group), while the remaining 2,943 (90.2%) who did not receive IO access formed the control group. Prehospital vasopressor administration was significantly more frequent in the IO group than in the control group (82.9% vs. 70.6%; p < 0.001; odds ratio [OR]: 1.77; 95% confidence interval [CI]: 1.28-2.46). However, the IO group showed a significant decrease in ROSC on hospital arrival (OR, 0.64; 95% CI: 0.45-0.91). No significant intergroup differences were observed in other secondary outcomes.
Conclusion: IO access was associated with increased prehospital vasopressor administration, suggesting higher success rates of IO vascular access among patients with OHCA in the helicopter emergency medical service setting.
Reference:Kudo H, Ohbe H, Kudo D, Sato T, Kushimoto S. Association Between Intraosseous Access Establishment and Prehospital Vasopressor Administration in Patients With Out-of-Hospital Cardiac Arrest in Helicopter Emergency Medical Services: Analysis of the Japanese Society for Aeromedical Services Registry. Air Med J. 2025 Sep-Oct;44(5):399-403. doi: 10.1016/j.amj.2025.06.016. Epub 2025 Jul 13. PMID: 40849156.