Intraosseous vs. intravenous access in out-of-hospital cardiac arrest: a systematic review and meta-analysis of clinical outcomes.

IF 2 Q2 EMERGENCY MEDICINE

International Journal of Emergency Medicine Pub Date : 2025-07-15 DOI:10.1186/s12245-025-00927-y

Emmanuel Kokori, Nawaf Al-Hashemi, Ziad Sad Aldeen, Ravi Patel, Nicholas Aderinto, Gbolahan Olatunji, Iyanuloluwa S Ojo, Israel Charles Abraham, Hafeez Shaka

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引用次数: 0

Abstract

Background: Out-of-hospital cardiac arrest (OHCA) is a critical emergency with low survival rates despite advancements in prehospital care. Timely vascular access for medication administration is essential, with intravenous (IV) and intraosseous (IO) access as primary strategies. While IO offers rapid and reliable access under challenging conditions, its effectiveness compared to IV access remains uncertain. This systematic review and meta-analysis evaluate the comparative outcomes of IO versus IV access in OHCA.

Methods: A systematic search of PubMed, Embase, SCOPUS, and other databases was conducted up to November 2024, following PRISMA guidelines. Studies were included comparing IO and IV access in OHCA and reporting outcomes such as return of spontaneous circulation (ROSC), 30-day survival, and neurological outcomes. Meta-analyses were performed using random-effects models to calculate pooled odds ratios (ORs) and mean differences. Heterogeneity was assessed using the I² statistic, and sensitivity analyses were conducted to evaluate the robustness.

Results: Nineteen studies involving ~ 140,000 observations (7 randomized controlled trials, 12 retrospective/observational) were analyzed. IO access was associated with significantly lower odds of ROSC (OR 0.75, 95% CI 0.65-0.85, p = 0.0003; 17 studies) and FNO at hospital discharge (OR 0.53, 95% CI 0.35-0.80, p = 0.0058; 12 studies) compared to IV access. The 30-day survival showed a non-significant trend favoring IV access (OR 0.59, 95% CI 0.28-1.21, p = 0.1088; 5 studies). Subgroup analyses revealed stronger IV advantages for shorter emergency medical services (EMS) response times (< 10 min; FNO: OR 0.55, ROSC: OR 0.75) and shockable rhythms (FNO: OR 0.53, ROSC: OR 0.75).

Conclusion: While IO access is a viable alternative when IV access is challenging, this study highlights its association with poorer survival and neurological outcomes in OHCA. The findings show the importance of prioritizing IV access. Further high-quality research is needed to refine recommendations for OHCA management.

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院外心脏骤停的骨内与静脉通路：临床结果的系统回顾和荟萃分析

院外心脏骤停（OHCA）是一种严重的紧急情况，尽管院前护理取得了进展，但生存率很低。及时进入血管给药至关重要，静脉（IV）和骨内（IO）通道是主要策略。虽然在具有挑战性的条件下，IO提供了快速和可靠的准入，但与静脉注射相比，其有效性仍然不确定。本系统综述和荟萃分析评估了OHCA中IO和IV通道的比较结果。方法：根据PRISMA指南，系统检索PubMed、Embase、SCOPUS等数据库，检索时间截止到2024年11月。研究包括比较OHCA中IO和IV通路，并报告诸如自然循环恢复（ROSC）、30天生存率和神经系统预后等结果。采用随机效应模型进行meta分析，计算合并优势比（or）和平均差异。采用I²统计量评估异质性，并进行敏感性分析以评估稳健性。结果：共纳入19项研究，涉及约14万观察结果（7项随机对照试验，12项回顾性/观察性试验）。IO访问与ROSC的发生率显著降低相关(OR 0.75, 95% CI 0.65-0.85, p = 0.0003；17项研究)和出院时的FNO (OR 0.53, 95% CI 0.35-0.80, p = 0.0058；12项研究)与静脉注射相比。30天生存率无显著性倾向于静脉注射(OR 0.59, 95% CI 0.28-1.21, p = 0.1088；5研究)。亚组分析显示，静脉注射在缩短紧急医疗服务（EMS）响应时间方面具有更强的优势(结论：当静脉注射具有挑战性时，静脉注射是一种可行的替代方案，但本研究强调了其与OHCA患者较差的生存率和神经系统预后的关联。研究结果表明，优先考虑静脉注射的重要性。需要进一步进行高质量的研究，以完善OHCA管理的建议。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Emergency Medicine EMERGENCY MEDICINE-

CiteScore

4.60

自引率

0.00%

发文量

审稿时长

13 weeks

期刊介绍： The aim of the journal is to bring to light the various clinical advancements and research developments attained over the world and thus help the specialty forge ahead. It is directed towards physicians and medical personnel undergoing training or working within the field of Emergency Medicine. Medical students who are interested in pursuing a career in Emergency Medicine will also benefit from the journal. This is particularly useful for trainees in countries where the specialty is still in its infancy. Disciplines covered will include interesting clinical cases, the latest evidence-based practice and research developments in Emergency medicine including emergency pediatrics.