EM Weekly.Emergency medicine literature

Historical collection · First published Oct 31, 2024; added to EM Weekly Oct 27, 2026. This retrospective summary may be superseded by later evidence or guidance.

Randomized trialNew England Journal of Medicine

A Randomized Trial of Drug Route in Out-of-Hospital Cardiac Arrest

Keith Couper, Chen Ji, Charles D Deakin, Rachael T Fothergill, Jerry P Nolan, John B Long, James M Mason, Felix Michelet, Chloe Norman, Henry Nwankwo, Tom Quinn, Anne-Marie Slowther, Michael A Smyth, Kath R Starr, Alison Walker, Sara Wood, Steve Bell, Gemma Bradley, Martina Brown, Shona Brown, Emma Burrow, Karl Charlton, Andrew Claxton Dip, Victoria Dra'gon, Christine Evans, Jakob Falloon, Theresa Foster, Justin Kearney, Nigel Lang, Matthew Limmer, Adam Mellett-Smith, Joshua Miller, Carla Mills, Ria Osborne, Nigel Rees, Robert E S Spaight, Gemma L Squires, Belinda Tibbetts, Michelle Waddington, Gregory A Whitley, Jason V Wiles, Julia Williams, Sarah Wiltshire, Adam Wright, Ranjit Lall, Gavin D Perkins, PARAMEDIC-3 CollaboratorsKeith Couper, Chen Ji, Charles D Deakin et al.

First online Oct 31, 2024On EM Weekly Oct 27, 2026Discovered Oct 27, 2026AI-generated Not yet human-reviewed

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Summary

PARAMEDIC-3 randomized 6,082 adults with OHCA requiring drug access to an IO-first or IV-first strategy. Thirty-day survival was 4.5% versus 5.1% (adjusted OR 0.94; 95% CI 0.68–1.32; P=.74). Favorable neurologic outcome at discharge was 2.7% versus 2.8%.

Why it matters

Rapid IO placement alone is not evidence of a survival advantage over starting with IV access. Preserve IO as an alternative when IV access is unsuccessful or impractical.

Study at a glance

Design: Randomized trial
Population: Adults with OHCA needing vascular access for drug treatment.
Sample size: 6082
Intervention: IO-first vascular access.
Comparator: IV-first vascular access.
Primary endpoint: Survival at 30 days.

Main findings

Any ROSC: 36.0% versus 39.1%; adjusted OR 0.86 (95% CI 0.76–0.97).
One adverse event was reported in the IO group.

Limitations

Open-label pragmatic strategy trial in 11 UK EMS systems. Low survival and wide confidence intervals limit certainty about modest differences; secondary analyses were not adjusted for multiplicity.

Read the primary source

Full text: Open-access full text available.

Original source

DOI: 10.1056/NEJMoa2407780

PMID: 39480216

Material reviewed: abstract.

Source retrieved Oct 27, 2026. Historical backfill. PubMed primary abstract and electronic publication date reviewed; the legal PMC author manuscript is available but was not reviewed in full.

Resuscitation

Corrections & review history

No corrections recorded. Human review: not yet human-reviewed.