Trial reportIntensive care medicine2020
Intraosseous versus intravenous administration of adrenaline in patients with out-of-hospital cardiac arrest: a secondary analysis of the PARAMEDIC2 placebo-controlled trial.
Trial report in Intensive care medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 7 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
25 citing papers in PubMed, 7 syntheses or guidelines pooled it, 69 citations in OpenAlex.
- Pooled it
- Intraosseous versus intravenous vascular access during out-of-hospital cardiac arrest: a systematic review and meta-analysis.Proceedings (Baylor University. Medical Center) · 2026Pooled it
- Intraosseous Versus Intravenous Vascular Access in Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.Medical sciences (Basel, Switzerland) · 2025Pooled it
- Effects of Intravenous Versus Intraosseous Adrenalin Administration on Morbidity and Mortality After Out-of-Hospital Cardiac Arrest: A Systematic Review.Medicina (Kaunas, Lithuania) · 2025Pooled it
- Intraosseous versus intravenous vascular access in out-of-hospital cardiac arrest: a systematic review and meta-analysis of randomized controlled trials.Critical care (London, England) · 2025Pooled it
- Intraosseous versus intravenous vascular access during cardiopulmonary resuscitation for out-of-hospital cardiac arrest: a systematic review and meta-analysis of observational studies.Scandinavian journal of trauma, resuscitation and emergency medicine · 2021Pooled it
- Systematic review and meta-analysis appraising efficacy and safety of adrenaline for adult cardiopulmonary resuscitation.Cardiology journal · 2021Pooled it
- Intramuscular epinephrine in cardiac arrest: A systematic review.Resuscitation plus · 2025Review
- Does the Injection Site Matter During CPR? A Systematic Review and Meta-Analysis of Drug Pharmacokinetics and Pharmacodynamics.Journal of clinical medicine · 2025Review
- Intraosseous vs. intravenous access in out-of-hospital cardiac arrest: a systematic review and meta-analysis of clinical outcomes.International journal of emergency medicine · 2025Review
- Safety and Efficacy of Intra-Osseous versus Intravenous Vascular Access for Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis.Therapeutics and clinical risk management · 2025Review
- Use of Epinephrine in Cardiac Arrest: Advances and Future Challenges.Medicina (Kaunas, Lithuania) · 2024Review
- Intraosseous and Intravenous Epinephrine Administration Routes in Out-of-Hospital Cardiac Arrest: Survival and Neurologic Outcomes.Journal of the American Heart Association · 2024Article
- Review
- Impact of intravenous accessibility and prehospital epinephrine use on survival outcomes of adult nontraumatic out-of-hospital cardiac arrest patients.BMC emergency medicine · 2024Article
- Trend of Outcome Metrics in Recent Out-of-Hospital-Cardiac-Arrest Research: A Narrative Review of Clinical Trials.Journal of clinical medicine · 2023Review
- Impact of the route of adrenaline administration in patients suffering from out-of-hospital cardiac arrest on 30-day survival with good neurological outcome (ETIVIO study).Scandinavian journal of trauma, resuscitation and emergency medicine · 2023Article
- Improving vasopressor use in cardiac arrest.Critical care (London, England) · 2023Review
- A Machine Learning Prediction Model for Non-cardiogenic Out-of-hospital Cardiac Arrest with Initial Non-shockable Rhythm.Juntendo Iji zasshi = Juntendo medical journal · 2023Article
- Drugs for advanced life support.Intensive care medicine · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 5 institutions in 1 country.
Funding
Abstract
purposeTo compare the effectiveness of the intravenous (IV) and intraosseous (IO) routes for drug administration in adults with a cardiac arrest enrolled in the Pre-Hospital Assessment of the Role of Adrenaline: Measuring the Effectiveness of Drug Administration in Cardiac Arrest (PARAMEDIC2) randomised, controlled trial.
methodsPatients were recruited from five National Health Service Ambulance Services in England and Wales from December 2014 through October 2017. Patients with an out-of-hospital cardiac arrest who were unresponsive to initial resuscitation attempts were randomly assigned to 1 mg adrenaline or matching placebo. Intravascular access was established as soon as possible, and IO access was considered if IV access was not possible after two attempts.
resultsAmong patients with out-of-hospital cardiac arrest, 3631 received adrenaline and 3686 received placebo. Amongst these, 1116 (30.1%) and 1121 (30.4%) received the study drug via the IO route. The odds ratios were similar in the IV and IO groups for return of spontaneous circulation (ROSC) at hospital handover [adjusted odds ratio (aOR) 4.07 (95% CI 3.42-4.85) and (aOR 3.98 (95% CI 2.86-5.53), P value for interaction 0.90]; survival to 30 days [aOR 1.67 (1.18-2.35) versus 0.9 (0.4-2.05), P = 0.18]; and favourable neurological outcome [aOR 1.39 (0.93-2.06) versus 0.62 (0.23-1.67), P = 0.14].
conclusionThere was no significant difference in treatment effect (adrenaline versus placebo) on ROSC at hospital handover between drugs administered by the intraosseous route or by the intravenous route. We could not detect any difference in the treatment effect between the IV and IO routes on the longer term outcomes of 30-day survival or favourable neurological outcome at discharge (ISRCTN73485024).
Indexed as
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.