Critical Care volume 29,
Article number: 124 (2025) Published: 19 March 2025
Background
Rapid and reliable vascular access is crucial during
cardiopulmonary resuscitation for out-of-hospital cardiac arrest (OHCA). While
intraosseous (IO) and intravenous (IV) access are used, their comparative
effectiveness for patient outcomes remains uncertain.
Methods
We searched PubMed, Embase, and ClinicalTrials.gov for RCTs
comparing IO vs. IV access in adults with OHCA. The primary outcome was
survival (30 days or until discharge), while secondary outcomes included
sustained ROSC, favorable neurological outcome, successful first-attempt
vascular access, and time from emergency medical service arrival to access.
Pooled odds ratios (OR), mean differences (MD), and 95% confidence intervals
(CI) were calculated.
Results
Four RCTs with 9475 patients were included. No significant
differences were found between IO and IV groups in survival (6.6% vs. 6.9%, OR
0.99, 95% CI 0.84–1.18) or favorable neurological outcome (4.7% vs. 4.6%, OR
1.07, 95% CI 0.88–1.30). The sustained ROSC rate was numerically, but not
significantly, lower in IO vs. IV access (24.6% vs. 27.0%, OR 0.92, 95% CI
0.80–1.06). IO access had a higher first-attempt success rate (92.3% vs. 62.3%;
OR 6.18, 95% CI 3.50–10.91) and was 15 s faster than IV for vascular
access (IO: 11.03 ± 5.57, IV:
11.35 ± 6.16 min, MD − 0.25, 95%
CI − 0.48 to − 0.01).
Conclusions
IO access had a higher first-attempt success rate and faster
establishment than IV access, but no significant differences were found in
survival or favorable neurological outcomes in adults with OHCA. Sustained ROSC
was numerically lower with IO access than IV access, although the difference
was not statistically significant.
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