Intraosseous Versus Intravenous Vascular Access for Out-Of-Hospital Cardiac Arrest: A Meta-Analysis of Randomized Clinical Trials

Background:  Out-of-hospital cardiac arrest (OHCA) is a life-threatening emergency characterized by low survival rates. Vascular access is critical for drug administration during resuscitation. While intravenous (IV) access is the standard, intraosseous (IO) access may provide practical advantages in certain emergencies.

Objectives:  This meta-analysis aimed to compare IO versus IV access in adult OHCA patients regarding their impact on survival and neurological outcomes.

Methods:  A systematic search of MEDLINE, Embase, and Cochrane CENTRAL through November 2024 was conducted, including randomized controlled trials (RCTs) comparing IO and IV access in adult patients with OHCA. Meta-analyses employed a random-effects model. A p-value < 0.05 was considered statistically significant. Analyses outcomes included survival with a favorable neurological outcome, survival to hospital discharge, return of spontaneous circulation (ROSC), and sustained ROSC. Subgroup analyses were conducted based on initial rhythm and bystander-performed cardiopulmonary resuscitation. The certainty of the evidence was determined using the GRADE approach. Results: Three RCTs involving 9,119 patients were included. IO access showed no significant differences compared to IV access in terms of survival with favorable neurological outcome (OR 1.07; 95% CI 0.88–1.30; p = 0.49; I² = 0%), survival to hospital discharge (OR 0.97; 95% CI 0.80–1.19; p = 0.80; I² = 0%), ROSC (OR 1.00; 95% CI 0.83–1.22; p = 0.97; I² = 64%), or sustained ROSC (OR 0.92; 95% CI 0.80–1.06; p = 0.25; I² = 44%).

Conclusions:  IO and IV access yield comparable outcomes in OHCA patients, supporting their use based on clinical context and provider expertise. Further research is needed to confirm these findings across diverse healthcare settings.

Keywords:
Out-of-Hospital Cardiac Arrest; Vascular Access Devices; Meta-Analysis