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Cardiac arrest
IO-first access likely inferior in OHCA
Intraosseous versus intravenous access in adult out-of-hospital cardiac arrest: a Bayesian secondary analysis of the PARAMEDIC-3 randomised controlled trial
Resuscitation · 2026-11 · Added 26 September 2026
A pre-planned Bayesian secondary analysis of the PARAMEDIC-3 RCT (6,082 adults with OHCA) found an intraosseous-first vascular access strategy was more likely harmful than beneficial, with an 81.6% posterior probability it was inferior to an intravenous-first strategy for 30-day survival.
- Study type
- RCT
- Design
- Bayesian secondary analysis of a randomised controlled trial
- Participants
- 6,082 adults with out-of-hospital cardiac arrest
- Main finding
- Posterior probability the IO-first strategy improved 30-day survival was 18.4%; probability it was inferior was 81.6%
- Caveat
- Secondary analysis with non-informative priors; the treatment effect is likely modest and the primary trial was neutral
- Bottom line
- Hypothesis-generating
Why it matters in Australia (High relevance). Vascular access in cardiac arrest is core practice everywhere in Australia, so this speaks directly to how crews work, and the effect is most likely modest rather than dramatic.
Learning goal
Weigh the evidence for intravenous versus intraosseous first-line access when managing adult out-of-hospital cardiac arrest.
More
- Topic: Cardiac arrest
- Daily scan: 26 September 2026
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