Comparison between Intraosseous and Central Venous Access in Adult Trauma Patients in the Emergency Room: A Systematic Review and Meta-analysis

Abstract

Comparison between Intraosseous and Central Venous Access in Adult the Room: A Meta-analysis. Background: Obtaining an efficient vascular access in a short-time is fundamental for the patient with hypovolemic shock in the emergency room. In case of peripheral venous access failure, the second option is not yet well defined. Objective: Critically appraise the literature on the use of intraosseous access and central venous access comparing these two interventions with respect to time to complete each of them, rate of success, and complications. Methods: The electronic databases used were MEDLINE / PubMed, PubMed Central, CAPES Platform, The Cochrane Library, EuroPMC, and Virtual Health Library (VHL). Literature reviews, conference proceedings, case reports, case series, comments, and correspondence were excluded, as were studies with children under 18 and a small sample. For the meta-analysis which estimated success in the first attempt, the odds ratios for success, the Mantel-Haenszel method was used for fixed effects. For the analysis of the execution time between procedures, the inverse variation method for fixed results was used. Meta-analysis calculations were performed using the Reviewer Manager 5.3 software. Results: A total of 144 studies were found, four of which were selected for the review, totaling 167 patients. There was superiority of intraosseous access in relation to central venous access with respect to the success rate in the first attempt (9.93; 95% CI 5.08–19.40; 0.00,001) and duration of the procedure (1.94; 95% CI 2.02–1.13; 0.00,001). All four studies comparing access found better performance and less time to perform intraosseous access compared to the central venous catheter. Conclusion: It is possible to determine that intraosseous vascular access is a safe, reliable, and a faster option in trauma patients in shock in the emergency room with inaccessible peripheral veins.