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Objective: During cardiac arrest, current guidelines recommend attempting intravenous access first and to consider intraosseous access if intravenous access is unsuccessful or impossible. However, these recommendations are only based on very low-certainty evidence. Therefore, the “Intravenous vs Intraosseous Vascular Access During Out-of-Hospital Cardiac Arrest“ (IVIO) trial aims to determine whether there is a difference in patient outcomes depending on the type of vascular access attempted during out-of-hospital cardiac arrest. This current article describes the clinical IVIO trial. Methods: The IVIO trial is an investigator-initiated, randomised trial of intravenous vs. intraosseous vascular access during adult non-traumatic out-of-hospital cardiac arrest in Denmark. The intervention will consist of minimum two attempts (if unsuccessful on the first attempt) to successfully establish intravenous or intraosseous vascular access during cardiac arrest. The intraosseous group will be further randomised to the humeral or tibial site. The primary outcome is sustained return of spontaneous circulation and key secondary outcomes include survival and survival with a favourable neurological outcome at 30 days. A total of 1,470 patients will be included. Results: The trial started in March 2022 and the last patient is anticipated to be included in the spring of 2024. The primary results will be reported after 90-day follow-up and are anticipated in mid-2024. Conclusion: The current article describes the design of the Danish IVIO trial. The findings of this trial will help inform future guidelines for selecting the optimal vascular access route during out-of-hospital cardiac arrest.

Introduction: Early recognition of out-of-hospital cardiac arrest (OHCA) by the medical dispatcher is a prerequisite for an effective chain of survival, leading to rapid dispatch of emergency medical services. Aim: To analyse and compare the accuracy of the Emergency Medical Dispatch Centre in identifying OHCA before and after an educational intervention. Methods: A quality-assessment study collecting data from prehospital medical voice logs in Southern Denmark during two periods. Baseline data and post-interventional data were obtained during December, January, and February 2017/2018 and 2019/2020, respectively. We imposed an intervention consisting of a specifically targeted education in quick assessment of OHCA and instructions regarding telephone-assisted-CPR.The primary outcome measure was the dispatcher's ability to recognise OHCA. Secondary outcome measures were time from contact with the caller to the dispatcher formulated essential questions related to the NO-NO-GO algorithm. These questions included an assessment of the patients’ consciousness and respiratory efforts and if both negative, would ideally lead to the dispatcher initiating telephone-assisted-CPR. All data was analysed in accordance with the recommendations and performance goals made by Resuscitation Academy. Results: Baseline data included 209 calls. Post-interventional data was based on 208 calls.The sensitivity for recognition of OHCA was 82.3% (95% CI: 76.4–87.2%) before and 92.7% (95% CI: 88.2–95.8%) after the intervention (p = 0.0014). The median duration of calls before recognition of OHCA was 68 and 56 s before and after the intervention (p = 0.097). Conclusion: After the period of intervention, the accuracy of OHCA recognition by dispatchers improved. The median time to identify OHCA or recognise the first compression did not differ significantly. This indicates that continuing education and quality assessment may be beneficial and necessary.