{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T09:25:16Z","timestamp":1784366716884,"version":"3.55.0"},"reference-count":30,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>While epinephrine is commonly administered in children with out-of-hospital cardiac arrest (OHCA) via an intraosseous (IO) or intravenous (IV) route, the optimal route of epinephrine delivery is unclear.<\/jats:p><\/jats:sec>Objective<\/jats:title>To evaluate the association between the route of epinephrine administration (IO or IV) and patient outcomes after pediatric OHCA.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>Retrospective cohort study of pediatric patients (aged &amp;lt;18 years) with nontraumatic OHCA treated by emergency medical services who received prehospital epinephrine either via an IO or IV route. Patients were included in the Resuscitation Outcomes Consortium Epidemiologic Registry, a prospective OHCA registry at 10 sites in the US and Canada from April 2011 to June 2015. Data analysis was performed from May 2024 to April 2025.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Epinephrine administration route: IO or IV route.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was survival to hospital discharge. The secondary outcome was return of spontaneous circulation (ROSC) before hospital arrival. Propensity scores were calculated and inverse probability of treatment weighting (IPTW) was performed with stabilized weights to control imbalances in measured patient demographics, cardiac arrest characteristics, and bystander and prehospital interventions.<\/jats:p><\/jats:sec>Results<\/jats:title>Of 739 eligible patients (median [IQR] age, 1 [0-11] years), 449 (60.8%) were male. Epinephrine was administered via an IO route for 535 (72.4%) and via an IV route for 204 (27.6%) patients. In the IPTW pseudopopulation (740 weighted cases), there was no significant difference in survival to hospital discharge (IO epinephrine: 28 of 528 patients [5.3%] vs IV epinephrine: 12 of 212 patients [5.7%]; risk ratio [RR], 0.92; 95% CI, 0.41-2.07) or prehospital ROSC (IO epinephrine: 76 of 528 patients [14.4%] vs IV epinephrine: 46 of 212 patients [21.7%]; RR, 0.66; 95% CI, 0.42-1.03) between the IO and IV epinephrine groups.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this retrospective cohort study of pediatric patients with OHCA in the US and Canada, the route of epinephrine administration was not associated with survival to hospital discharge or prehospital ROSC. This may support the practice of administering epinephrine via IO or IV route.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.17291","type":"journal-article","created":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T15:31:15Z","timestamp":1750865475000},"page":"e2517291","source":"Crossref","is-referenced-by-count":3,"title":["Intraosseous vs Intravenous Access for Epinephrine in Pediatric Out-of-Hospital Cardiac Arrest"],"prefix":"10.1001","volume":"8","author":[{"given":"Masashi","family":"Okubo","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sho","family":"Komukai","sequence":"additional","affiliation":[{"name":"Division of Biomedical Statistics, Department of Integrated Medicine, Osaka University, Graduate School of Medicine, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junichi","family":"Izawa","sequence":"additional","affiliation":[{"name":"Division of Intensive Care Medicine, Okinawa Prefectural Chubu Hospital, Okinawa, Japan"},{"name":"Department of Preventive Services, Kyoto University Graduate School of Public Health, Kyoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"SunHee","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Oregon Health and Science University, Portland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cameron","family":"Dezfulian","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children\u2019s Hospital, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis X.","family":"Guyette","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua R.","family":"Lupton","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Oregon Health and Science University, Portland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Martin-Gill","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvia","family":"Owusu-Ansah","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, University of Pennsylvania Medical Center Children\u2019s Hospital of Pittsburgh, Pittsburgh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sriram","family":"Ramgopal","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Ann and Robert H. 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