Abstract：
BACKGROUND: Obtaining vascular access is crucial in critically ill patients. The EZ-IO® device is easy to use and has a high insertion success rate. Therefore, the use of intraosseous vascular access (IOVA) has gradually increased.
OBJECTIVE: We aim to determine how IOVA was integrated into management of vascular access during out-of-hospital cardiac arrest (OHCA) resuscitation.
METHODS: Analysing the data from the OHCA French registry for events occurring between 1 January 2013 and 15 March 2021, we studied: demography, circumstances of occurrence and management including vascular access, delays and evolution. The primary outcome was the rate of IOVA implantation.
RESULTS: Among the 7156 OHCA included in the registry, we analysed the 3964 (55%) who received cardiopulmonary resuscitation. The vascular access was peripheral in 3122 (79%) cases, intraosseous in 775 (20%) cases and central in 12 (<1%) cases. The use of IOVA has increased linearly (R2 = 0.61) during the 33 successive trimesters studied representing 7% of all vascular access in 2013 and 33% in 2021 (p = 0.001). It was significantly more frequent in traumatic cardiac arrest: 12% versus 5%; p < 0.0001. The first epinephrine bolus occurred significantly later in the IOVA group, at 6 (4-10) versus 5 (3-8) min; p < 0.0001. Survival rate in the IOVA group was significantly lower, at 1% versus 7%; p < 0.0001.
CONCLUSIONS: The insertion rate of IOVA significantly increased over the studied period, to reach 30% of all vascular access in the management OHCA patients. The place of the intraosseous route in the strategy of venous access during the management of prehospital cardiac arrest has yet to be determined.
OBJECTIVE: We aim to determine how IOVA was integrated into management of vascular access during out-of-hospital cardiac arrest (OHCA) resuscitation.
METHODS: Analysing the data from the OHCA French registry for events occurring between 1 January 2013 and 15 March 2021, we studied: demography, circumstances of occurrence and management including vascular access, delays and evolution. The primary outcome was the rate of IOVA implantation.
RESULTS: Among the 7156 OHCA included in the registry, we analysed the 3964 (55%) who received cardiopulmonary resuscitation. The vascular access was peripheral in 3122 (79%) cases, intraosseous in 775 (20%) cases and central in 12 (<1%) cases. The use of IOVA has increased linearly (R2 = 0.61) during the 33 successive trimesters studied representing 7% of all vascular access in 2013 and 33% in 2021 (p = 0.001). It was significantly more frequent in traumatic cardiac arrest: 12% versus 5%; p < 0.0001. The first epinephrine bolus occurred significantly later in the IOVA group, at 6 (4-10) versus 5 (3-8) min; p < 0.0001. Survival rate in the IOVA group was significantly lower, at 1% versus 7%; p < 0.0001.
CONCLUSIONS: The insertion rate of IOVA significantly increased over the studied period, to reach 30% of all vascular access in the management OHCA patients. The place of the intraosseous route in the strategy of venous access during the management of prehospital cardiac arrest has yet to be determined.
摘要：
背景：在危重患者中获得血管通路至关重要。EZ-IO®设备易于使用，具有很高的插入成功率。因此,骨内血管通路(IOVA)的使用逐渐增加.
目的：我们的目的是确定如何在院外心脏骤停（OHCA）复苏期间将IOVA整合到血管通路管理中。
方法：分析2013年1月1日至2021年3月15日之间发生的事件的OHCA法国注册数据，我们研究：人口统计学，发生和管理的情况，包括血管通路，延迟和进化。主要结果是IOVA植入率。
结果：在注册表中包含的7156OHCA中，我们分析了3964名(55%)接受心肺复苏的患者.3122例(79%)血管通路为外周,骨内775例（20％），中央12例（<1％）。在研究的33个连续三个月中，IOVA的使用线性增加（R2=0.61），占2013年所有血管通路的7％和2021年的33％（p=0.001）。在创伤性心脏骤停中明显更频繁:12%对5%;p<0.0001。第一次肾上腺素推注明显晚于IOVA组，在6（4-10）对5（3-8）分钟；p<0.0001。IOVA组的生存率明显降低，1%对7%；p<0.0001。
结论：在研究期间，IOVA的插入率显着增加，达到管理OHCA患者所有血管通路的30%。在院前心脏骤停的管理过程中，骨内途径在静脉通路策略中的位置尚未确定。
目的：我们的目的是确定如何在院外心脏骤停（OHCA）复苏期间将IOVA整合到血管通路管理中。
方法：分析2013年1月1日至2021年3月15日之间发生的事件的OHCA法国注册数据，我们研究：人口统计学，发生和管理的情况，包括血管通路，延迟和进化。主要结果是IOVA植入率。
结果：在注册表中包含的7156OHCA中，我们分析了3964名(55%)接受心肺复苏的患者.3122例(79%)血管通路为外周,骨内775例（20％），中央12例（<1％）。在研究的33个连续三个月中，IOVA的使用线性增加（R2=0.61），占2013年所有血管通路的7％和2021年的33％（p=0.001）。在创伤性心脏骤停中明显更频繁:12%对5%;p<0.0001。第一次肾上腺素推注明显晚于IOVA组，在6（4-10）对5（3-8）分钟；p<0.0001。IOVA组的生存率明显降低，1%对7%；p<0.0001。
结论：在研究期间，IOVA的插入率显着增加，达到管理OHCA患者所有血管通路的30%。在院前心脏骤停的管理过程中，骨内途径在静脉通路策略中的位置尚未确定。
