Femoral central venous access during emergency department cardiac arrest and sustained return of spontaneous circulation: 10‐min landmark cohort

Abstract Background Femoral central venous catheterization (CVC) during ongoing emergency department (ED) cardiopulmonary resuscitation (CPR) may improve medication delivery and influence resuscitation outcomes, but observational comparisons are prone to time‐dependent bias. Objective To assess the association between achieving femoral central venous access within 10 min of arrest recognition and outcomes. Methods This was a prospective observational cohort of adult ED arrests from December 1, 2023 to December 1, 2025. The landmark cohort included patients with ongoing CPR at 10 min and no return of spontaneous circulation (ROSC) before 10 min. Exposure was femoral CVC functional and used for medication delivery by 10 min versus no femoral CVC by 10 min. Primary outcome was sustained ROSC (≥20 min) after the landmark. Adjusted risk ratios (aRR) were estimated using modified Poisson regression (robust SE), adjusting for age, sex, initial rhythm, and presumed etiology. Results Of 189 arrests, 87 met landmark criteria; 36 had functional femoral CVC by 10 min and 51 had no femoral CVC. Time to first epinephrine was similar (2.5 vs. 2.4 min; p = 0.28); total epinephrine dose was higher with CVC (6 vs. 5 mg; p = 0.048). Sustained ROSC after the landmark occurred in 13/36 (36.1%) in the femoral CVC group versus 10/51 (19.6%) in the no femoral CVC group (risk difference 16.5%; unadjusted risk ratio 1.84). After adjustment, femoral CVC by 10 min was associated with higher sustained ROSC (aRR 1.63, 95% CI 1.00–2.67; p = 0.049). Survival to discharge and cerebral performance category 1–2 were similar. Conclusion In prolonged ED arrests, femoral CVC functional by 10 min showed an association with higher sustained ROSC after the landmark; patient‐centered outcomes were inconclusive.