Comparison of intraosseous line placement location and rates of return of spontaneous circulation and survival to discharge among patients with out-of-hospital cardiac arrest

OBJECTIVE: Establishment of vascular access via intraosseous (IO) line is common practice during out-of-hospital cardiac arrest (OHCA). Few studies have examined patient outcomes as they relate to IO placement location. Our study aims to compare outcomes including return of spontaneous circulation (ROSC), survival to discharge, and neurological status upon discharge among OHCA patients that received humeral IO versus tibial IO placement for medication administration. METHODS: This retrospective study analyzed data from the Riverside County High Performance Resuscitation Training Cardiac Arrest Registry, which consolidates non-traumatic cardiac arrests from emergency medical service (EMS) agencies in Riverside County, California. The study included patients (≥16 years) treated between 2020 and 2023. RESULTS: 1920 cases were examined which included 246 with humeral IO placement (12.8%) and 1674 with tibial IO placement (87.2%). Humeral IO placement was nearly two times more likely to achieve ROSC (1.85, [1.39, 2.50], p < 0.0001). After adjusting for additional factors including age, sex, initial rhythm, and compression fraction, the association was stronger (2.55, [1.54, 4.22], p = 0.0003). Humeral IO placement was also twice as likely to be discharged (2.04, [1.03, 4.17], p < 0.050). There was insufficient power (n = 49) to assess neurologic status at discharge. CONCLUSION: The data suggests that humeral IO placement may be associated with higher rates of ROSC and survival to hospital discharge when compared to tibial IO placement. Further controlled studies may be needed to help guide possible protocol changes when discussing optimal IO placement in cardiac arrest.