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

Q3 Nursing

Air Medical Journal Pub Date : 2025-07-13 DOI:10.1016/j.amj.2025.06.016

Hidemasa Kudo MD , Hiroyuki Ohbe PhD , Daisuke Kudo PhD , Tetsuya Sato PhD , Shigeki Kushimoto PhD

{"title":"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","authors":"Hidemasa Kudo MD , Hiroyuki Ohbe PhD , Daisuke Kudo PhD , Tetsuya Sato PhD , Shigeki Kushimoto PhD","doi":"10.1016/j.amj.2025.06.016","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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%; <em>p</em> < 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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Pages 399-403"},"PeriodicalIF":0.0000,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Air Medical Journal","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1067991X25002020","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Nursing","Score":null,"Total":0}

引用次数: 0

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.

查看原文本刊更多论文

直升机紧急医疗服务中院外心脏骤停患者骨内通道建立与院前血管加压药使用的关系：日本航空医疗服务协会注册的分析

目的建立院外心脏骤停（OHCA）患者骨内通道，实现可靠的血管加压药物给药。然而，在全国院前设置中，没有研究检查IO通路和血管加压剂给药之间的关系。我们的目的是通过一个全国性的数据库来研究OHCA患者的IO通路和血管加压药的使用之间的关系。方法本回顾性队列研究使用了2020年4月至2023年3月期间日本航空医疗服务协会（JSAS-R）的数据。主要终点是到达医院前血管加压药的使用。次要结局包括住院死亡率、住院时间、医生到达医院的时间和到达医院时的自然循环恢复（ROSC）。采用多变量逻辑回归和多重输入检验IO通路建立与临床结果之间的关系。结果3264例OHCA患者中，有321例（9.8%）接受了IO通路（IO组），其余2943例（90.2%）未接受IO通路（对照组）。IO组院前给药血管加压素的频率明显高于对照组（82.9% vs. 70.6%; p < 0.001；优势比[OR]: 1.77； 95%可信区间[CI]: 1.28-2.46）。然而，IO组在到达医院时ROSC显著降低（OR, 0.64; 95% CI: 0.45-0.91）。其他次要结果组间无显著差异。结论院前血管加压剂的使用增加了IO通道的使用，表明直升机紧急医疗服务环境下OHCA患者IO通道的成功率更高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Air Medical Journal Nursing-Emergency Nursing

CiteScore

1.20

自引率

0.00%

发文量

112

审稿时长

69 days

期刊介绍： Air Medical Journal is the official journal of the five leading air medical transport associations in the United States. AMJ is the premier provider of information for the medical transport industry, addressing the unique concerns of medical transport physicians, nurses, pilots, paramedics, emergency medical technicians, communication specialists, and program administrators. The journal contains practical how-to articles, debates on controversial industry issues, legislative updates, case studies, and peer-reviewed original research articles covering all aspects of the medical transport profession.