The pharmacokinetics of medication delivery through intraosseous 12 (IO) access is not well characterized in in-hospital cardiac arrest 13 (IHCA) during resuscitation. We commend Schwalbach et al. for their 14 outstanding work on this subject as it certainly adds value to the cur-15 rent literature. 1 After reviewing this article, we would like to share 16 some comments.17It's mentioned in the introduction that the primary aim of the study 18 is to "compare outcomes between IO and peripheral intravenous 19 (PIV) injection during IHCA". We are not sure what kind of injection 20 they are referring to here. 21 As stated in the methods section, medical and surgical patients in 22 intensive care, acute care, and procedural areas were included in the 23 study, however, it's not clear if patients from the hospital floor were 24 also included. If they were not included, we are concerned that the 25 study population didn't truly represent the "in-hospital" population, 26 which was the target population of this study.
27The IO access was placed if there was no pre-existing PIV 28 access, or a PIV access was not placed before the Medical Emer-29 gency Team's (MET) arrival. Although the authors admitted their 30 inability to distinguish between patients who had a pre-existing PIV 31 access and those who had PIV placed after IHCA in the limitations 32 section, it's important to know the number of patients with pre-exist-33 ing PIV access as they could have a shorter time-to-epinephrine 34 (TTE) and time-to-ROSC compared to those who had PIV placed 35 after IHCA. Also, we are interested to know if the time from initiation 36 of Advanced Cardiac Life Support (ACLS) guideline to the time of 37 access placement was matched between PIV and IO groups. The 38 fact that IO placement can take longer than PIV placement may skew 39 the results in the favor of the PIV group. Additionally, IO access was 40 also placed at the discretion of the attending physician, yet there is 41 no guideline mentioned in the article on how the attending physician 42 decided the need for IO placement. Furthermore, humeral placement 43 was only obtained if there was failure or contraindication at tibial 44 location, but they neither provided the details of those contraindica-45 tions, nor the total number of patients requiring humeral placement. 46 All IHCA were responded by the MET nurses for this study. We 47 are thus eager to know if the time of MET arrival from the time of 48 ACLS initiation, as well as the time elapsed between MET arrival 49 and access placement was recorded for each patient, as this time 50 can vary among patients and compromise the validity of the results.51 As per table 1, out of the 1039 patients, 898 had a witnessed car-52 diac arrest, meaning that 141 didn't have a witnessed arrest. We 53 would like to know if those 141 patients were included in the study. 54 If included, we'd like to know their primary and secondary outcomes 55 compared to the patients with witnessed arrest, especially given the 56 fact that there is a statistic...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.