Effect of Vascular Access Strategy on Long-Term Outcomes in Patients with Out-of-hospital Cardiac Arrest A Randomised Clinical Trial

Mikael Fink Vallentin; Mathias J Holmberg; Asger Granfeldt; Thomas Lass Klitgaard; Søren Mikkelsen; Fredrik Folke; Helle Collatz Christensen; Amalie Ling Povlsen; Alberthe Hjort Petersen; Sofie Winther; Lea Wildt Frilund; Carsten Meilandt; Kristian Blumensaadt Winther; Allan Bach; Thomas H Dissing; Christian Juhl Terkelsen; Steffen Christensen; Line Kirkegaard Rasmussen; Lone Riis Mortensen; Thomas Elkmann; Anders Gunnar Nielsen; Charlotte Runge; Elise Klæstrup; Jimmy Højberg Holm; Mikkel Bak; Lars-Gustav Rahbek Nielsen; Mette Pedersen; Gunhild Kjærgaard-Andersen; Peter Martin Hansen; Anne Craveiro Brøchner; Erika Frischknecht Christensen; Frederik Mølgaard Nielsen; Christian Gade Nissen; Jeppe Waldstrøm Bjørn; Peter Burholt; Laust E R Obling; Sarah Louise Duus Holle; Lene Russell; Henrik Alstrøm; Søren Hestad; Jens Ulrik Hove Buciek; Karina Jakobsen; Mette Krag; Michael Sandgaard; Birthe Sindberg; Lars W Andersen

doi:10.1016/j.resuscitation.2026.111087

Effect of Vascular Access Strategy on Long-Term Outcomes in Patients with Out-of-hospital Cardiac Arrest A Randomised Clinical Trial

Mikael Fink Vallentin, Mathias J Holmberg, Asger Granfeldt, Thomas Lass Klitgaard, Søren Mikkelsen, Fredrik Folke, Helle Collatz Christensen, Amalie Ling Povlsen, Alberthe Hjort Petersen, Sofie Winther, Lea Wildt Frilund, Carsten Meilandt, Kristian Blumensaadt Winther, Allan Bach, Thomas H Dissing, Christian Juhl Terkelsen, Steffen Christensen, Line Kirkegaard Rasmussen, Lone Riis Mortensen, Thomas ElkmannAnders Gunnar Nielsen, Charlotte Runge, Elise Klæstrup, Jimmy Højberg Holm, Mikkel Bak, Lars-Gustav Rahbek Nielsen, Mette Pedersen, Gunhild Kjærgaard-Andersen, Peter Martin Hansen, Anne Craveiro Brøchner, Erika Frischknecht Christensen, Frederik Mølgaard Nielsen, Christian Gade Nissen, Jeppe Waldstrøm Bjørn, Peter Burholt, Laust E R Obling, Sarah Louise Duus Holle, Lene Russell, Henrik Alstrøm, Søren Hestad, Jens Ulrik Hove Buciek, Karina Jakobsen, Mette Krag, Michael Sandgaard, Birthe Sindberg, Lars W Andersen^*

^*Corresponding author for this work

Abstract

OBJECTIVE: The Intravenous versus Intraosseous Vascular Access for Out-of-Hospital Cardiac Arrest (IVIO) trial was a randomised clinical trial that investigated initial vascular access strategy for out-of-hospital cardiac arrest. The current manuscript presents outcomes at 6 months and 1 year.

METHODS: Adults with non-traumatic out-of-hospital cardiac arrest, in whom vascular access was indicated, were randomised to initial intraosseous or intravenous access. The allocated method was attempted up to two times. Prespecified 6-months and 1-year outcomes included survival, survival with a favourable neurological outcome, defined as a modified Rankin Scale score of 0-3, and health-related quality-of-life assessed using the EuroQoL 5-Dimension 5-Level questionnaire on domains of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression.

RESULTS: Of the 1479 patients included in the main manuscript primary analyses, three were lost to follow-up for 1-year survival. At 1 year, 82 patients (11%) in the intraosseous group and 68 patients (9%) in the intravenous group were alive (risk ratio 1.24; 95% confidence interval 0.91-1.67). Survival with a favourable neurological outcome was observed in 76 patients (10%) and 61 patients (8%), respectively (risk ratio 1.28; 95% confidence interval 0.93-1.77). Among survivors, the mean EQ-5D-5L numeric score was 83 in the intraosseous group and 76 in the intravenous group (mean difference 7; 95% confidence interval 1-13).

CONCLUSION: Long-term outcomes were similar between patients who received initial intraosseous versus intravenous vascular access during adult out-of-hospital cardiac arrest. These findings do not support a difference in patient outcomes between the two vascular access strategies.

TRIAL REGISTRATION: EU Clinical Trials number 2022-500744-38-00; ClinicalTrials.gov number NCT05205031.

Original language	English
Article number	111087
Journal	Resuscitation
Volume	223
ISSN	0300-9572
DOIs	https://doi.org/10.1016/j.resuscitation.2026.111087
Publication status	Published - 2026

Keywords

Advanced life support
Cardiac arrest
Clinical trial
Vascular access

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Vallentin, M. F., Holmberg, M. J., Granfeldt, A., Klitgaard, T. L., Mikkelsen, S., Folke, F., Christensen, H. C., Povlsen, A. L., Petersen, A. H., Winther, S., Frilund, L. W., Meilandt, C., Winther, K. B., Bach, A., Dissing, T. H., Terkelsen, C. J., Christensen, S., Rasmussen, L. K., Mortensen, L. R., ... Andersen, L. W. (2026). Effect of Vascular Access Strategy on Long-Term Outcomes in Patients with Out-of-hospital Cardiac Arrest A Randomised Clinical Trial. Resuscitation, 223, Article 111087. https://doi.org/10.1016/j.resuscitation.2026.111087

Vallentin, MF, Holmberg, MJ, Granfeldt, A, Klitgaard, TL, Mikkelsen, S, Folke, F, Christensen, HC, Povlsen, AL, Petersen, AH, Winther, S, Frilund, LW, Meilandt, C, Winther, KB, Bach, A, Dissing, TH, Terkelsen, CJ, Christensen, S, Rasmussen, LK, Mortensen, LR, Elkmann, T, Nielsen, AG, Runge, C, Klæstrup, E, Holm, JH, Bak, M, Nielsen, L-GR, Pedersen, M, Kjærgaard-Andersen, G, Hansen, PM, Brøchner, AC, Christensen, EF, Nielsen, FM, Nissen, CG, Bjørn, JW, Burholt, P, Obling, LER , Duus Holle, SL , Russell, L , Alstrøm, H , Hestad, S, Hove Buciek, JU, Jakobsen, K, Krag, M, Sandgaard, M, Sindberg, B & Andersen, LW 2026, 'Effect of Vascular Access Strategy on Long-Term Outcomes in Patients with Out-of-hospital Cardiac Arrest A Randomised Clinical Trial', Resuscitation, vol. 223, 111087. https://doi.org/10.1016/j.resuscitation.2026.111087

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title = "Effect of Vascular Access Strategy on Long-Term Outcomes in Patients with Out-of-hospital Cardiac Arrest A Randomised Clinical Trial",

abstract = "OBJECTIVE: The Intravenous versus Intraosseous Vascular Access for Out-of-Hospital Cardiac Arrest (IVIO) trial was a randomised clinical trial that investigated initial vascular access strategy for out-of-hospital cardiac arrest. The current manuscript presents outcomes at 6 months and 1 year.METHODS: Adults with non-traumatic out-of-hospital cardiac arrest, in whom vascular access was indicated, were randomised to initial intraosseous or intravenous access. The allocated method was attempted up to two times. Prespecified 6-months and 1-year outcomes included survival, survival with a favourable neurological outcome, defined as a modified Rankin Scale score of 0-3, and health-related quality-of-life assessed using the EuroQoL 5-Dimension 5-Level questionnaire on domains of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression.RESULTS: Of the 1479 patients included in the main manuscript primary analyses, three were lost to follow-up for 1-year survival. At 1 year, 82 patients (11\%) in the intraosseous group and 68 patients (9\%) in the intravenous group were alive (risk ratio 1.24; 95\% confidence interval 0.91-1.67). Survival with a favourable neurological outcome was observed in 76 patients (10\%) and 61 patients (8\%), respectively (risk ratio 1.28; 95\% confidence interval 0.93-1.77). Among survivors, the mean EQ-5D-5L numeric score was 83 in the intraosseous group and 76 in the intravenous group (mean difference 7; 95\% confidence interval 1-13).CONCLUSION: Long-term outcomes were similar between patients who received initial intraosseous versus intravenous vascular access during adult out-of-hospital cardiac arrest. These findings do not support a difference in patient outcomes between the two vascular access strategies.TRIAL REGISTRATION: EU Clinical Trials number 2022-500744-38-00; ClinicalTrials.gov number NCT05205031.",

keywords = "Advanced life support, Cardiac arrest, Clinical trial, Vascular access",

author = "Vallentin, \{Mikael Fink\} and Holmberg, \{Mathias J\} and Asger Granfeldt and Klitgaard, \{Thomas Lass\} and S{\o}ren Mikkelsen and Fredrik Folke and Christensen, \{Helle Collatz\} and Povlsen, \{Amalie Ling\} and Petersen, \{Alberthe Hjort\} and Sofie Winther and Frilund, \{Lea Wildt\} and Carsten Meilandt and Winther, \{Kristian Blumensaadt\} and Allan Bach and Dissing, \{Thomas H\} and Terkelsen, \{Christian Juhl\} and Steffen Christensen and Rasmussen, \{Line Kirkegaard\} and Mortensen, \{Lone Riis\} and Thomas Elkmann and Nielsen, \{Anders Gunnar\} and Charlotte Runge and Elise Kl{\ae}strup and Holm, \{Jimmy H{\o}jberg\} and Mikkel Bak and Nielsen, \{Lars-Gustav Rahbek\} and Mette Pedersen and Gunhild Kj{\ae}rgaard-Andersen and Hansen, \{Peter Martin\} and Br{\o}chner, \{Anne Craveiro\} and Christensen, \{Erika Frischknecht\} and Nielsen, \{Frederik M{\o}lgaard\} and Nissen, \{Christian Gade\} and Bj{\o}rn, \{Jeppe Waldstr{\o}m\} and Peter Burholt and Obling, \{Laust E R\} and \{Duus Holle\}, \{Sarah Louise\} and Lene Russell and Henrik Alstr{\o}m and S{\o}ren Hestad and \{Hove Buciek\}, \{Jens Ulrik\} and Karina Jakobsen and Mette Krag and Michael Sandgaard and Birthe Sindberg and Andersen, \{Lars W\}",

year = "2026",

doi = "10.1016/j.resuscitation.2026.111087",

language = "English",

volume = "223",

journal = "Resuscitation",

issn = "0300-9572",

publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Effect of Vascular Access Strategy on Long-Term Outcomes in Patients with Out-of-hospital Cardiac Arrest A Randomised Clinical Trial

AU - Vallentin, Mikael Fink

AU - Holmberg, Mathias J

AU - Granfeldt, Asger

AU - Klitgaard, Thomas Lass

AU - Mikkelsen, Søren

AU - Folke, Fredrik

AU - Christensen, Helle Collatz

AU - Povlsen, Amalie Ling

AU - Petersen, Alberthe Hjort

AU - Winther, Sofie

AU - Frilund, Lea Wildt

AU - Meilandt, Carsten

AU - Winther, Kristian Blumensaadt

AU - Bach, Allan

AU - Dissing, Thomas H

AU - Terkelsen, Christian Juhl

AU - Christensen, Steffen

AU - Rasmussen, Line Kirkegaard

AU - Mortensen, Lone Riis

AU - Elkmann, Thomas

AU - Nielsen, Anders Gunnar

AU - Runge, Charlotte

AU - Klæstrup, Elise

AU - Holm, Jimmy Højberg

AU - Bak, Mikkel

AU - Nielsen, Lars-Gustav Rahbek

AU - Pedersen, Mette

AU - Kjærgaard-Andersen, Gunhild

AU - Hansen, Peter Martin

AU - Brøchner, Anne Craveiro

AU - Christensen, Erika Frischknecht

AU - Nielsen, Frederik Mølgaard

AU - Nissen, Christian Gade

AU - Bjørn, Jeppe Waldstrøm

AU - Burholt, Peter

AU - Obling, Laust E R

AU - Duus Holle, Sarah Louise

AU - Russell, Lene

AU - Alstrøm, Henrik

AU - Hestad, Søren

AU - Hove Buciek, Jens Ulrik

AU - Jakobsen, Karina

AU - Krag, Mette

AU - Sandgaard, Michael

AU - Sindberg, Birthe

AU - Andersen, Lars W

PY - 2026

Y1 - 2026

N2 - OBJECTIVE: The Intravenous versus Intraosseous Vascular Access for Out-of-Hospital Cardiac Arrest (IVIO) trial was a randomised clinical trial that investigated initial vascular access strategy for out-of-hospital cardiac arrest. The current manuscript presents outcomes at 6 months and 1 year.METHODS: Adults with non-traumatic out-of-hospital cardiac arrest, in whom vascular access was indicated, were randomised to initial intraosseous or intravenous access. The allocated method was attempted up to two times. Prespecified 6-months and 1-year outcomes included survival, survival with a favourable neurological outcome, defined as a modified Rankin Scale score of 0-3, and health-related quality-of-life assessed using the EuroQoL 5-Dimension 5-Level questionnaire on domains of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression.RESULTS: Of the 1479 patients included in the main manuscript primary analyses, three were lost to follow-up for 1-year survival. At 1 year, 82 patients (11%) in the intraosseous group and 68 patients (9%) in the intravenous group were alive (risk ratio 1.24; 95% confidence interval 0.91-1.67). Survival with a favourable neurological outcome was observed in 76 patients (10%) and 61 patients (8%), respectively (risk ratio 1.28; 95% confidence interval 0.93-1.77). Among survivors, the mean EQ-5D-5L numeric score was 83 in the intraosseous group and 76 in the intravenous group (mean difference 7; 95% confidence interval 1-13).CONCLUSION: Long-term outcomes were similar between patients who received initial intraosseous versus intravenous vascular access during adult out-of-hospital cardiac arrest. These findings do not support a difference in patient outcomes between the two vascular access strategies.TRIAL REGISTRATION: EU Clinical Trials number 2022-500744-38-00; ClinicalTrials.gov number NCT05205031.

AB - OBJECTIVE: The Intravenous versus Intraosseous Vascular Access for Out-of-Hospital Cardiac Arrest (IVIO) trial was a randomised clinical trial that investigated initial vascular access strategy for out-of-hospital cardiac arrest. The current manuscript presents outcomes at 6 months and 1 year.METHODS: Adults with non-traumatic out-of-hospital cardiac arrest, in whom vascular access was indicated, were randomised to initial intraosseous or intravenous access. The allocated method was attempted up to two times. Prespecified 6-months and 1-year outcomes included survival, survival with a favourable neurological outcome, defined as a modified Rankin Scale score of 0-3, and health-related quality-of-life assessed using the EuroQoL 5-Dimension 5-Level questionnaire on domains of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression.RESULTS: Of the 1479 patients included in the main manuscript primary analyses, three were lost to follow-up for 1-year survival. At 1 year, 82 patients (11%) in the intraosseous group and 68 patients (9%) in the intravenous group were alive (risk ratio 1.24; 95% confidence interval 0.91-1.67). Survival with a favourable neurological outcome was observed in 76 patients (10%) and 61 patients (8%), respectively (risk ratio 1.28; 95% confidence interval 0.93-1.77). Among survivors, the mean EQ-5D-5L numeric score was 83 in the intraosseous group and 76 in the intravenous group (mean difference 7; 95% confidence interval 1-13).CONCLUSION: Long-term outcomes were similar between patients who received initial intraosseous versus intravenous vascular access during adult out-of-hospital cardiac arrest. These findings do not support a difference in patient outcomes between the two vascular access strategies.TRIAL REGISTRATION: EU Clinical Trials number 2022-500744-38-00; ClinicalTrials.gov number NCT05205031.

KW - Advanced life support

KW - Cardiac arrest

KW - Clinical trial

KW - Vascular access

UR - https://www.scopus.com/pages/publications/105036713353

U2 - 10.1016/j.resuscitation.2026.111087

DO - 10.1016/j.resuscitation.2026.111087

M3 - Journal article

C2 - 41967754

SN - 0300-9572

VL - 223

JO - Resuscitation

JF - Resuscitation

M1 - 111087

ER -

Effect of Vascular Access Strategy on Long-Term Outcomes in Patients with Out-of-hospital Cardiac Arrest A Randomised Clinical Trial

Abstract

Keywords

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