TY - JOUR
T1 - Intravenous Versus Intraosseous Vascular Access in Out-of-Hospital Cardiac Arrest
T2 - A Meta-Analysis
AU - Hameed, Hira
AU - Fahad, Muhammad
AU - Sharif, Samia
AU - Nazir, Ayesha
AU - Sajid, Furqan
AU - Mainka, F. N.U.
AU - Ali, Qasim
AU - Qasim, Tahreem
AU - Amin, Shamaoon
AU - Saghir, Muhammad Hamza
AU - Ahmed, Mushood
AU - Cheema, Huzaifa Ahmad
AU - Ahmad, Adeel
AU - Baniowda, Muath
AU - Neppala, Sivaram
N1 - Publisher Copyright:
© 2025 Lippincott Williams and Wilkins. All rights reserved.
PY - 2025
Y1 - 2025
N2 - Establishing vascular access early in out-of-hospital cardiac arrest (OHCA) is a crucial factor for improving prognosis. Clinical guidelines recommend both intravascular (IV) and intraosseous (IO) access, but the superiority of one technique over the other has yet to be determined. Our review aimed to compare the efficacy and safety of IV versus IO access in OHCA. A comprehensive search was conducted on PubMed/MEDLINE, Embase, and Cochrane Library from inception till January 2025 for randomized controlled trials or their subgroup analyses comparing IV versus IO access in adult OHCA patients. The data for clinical outcomes were extracted, and forest plots were generated using the random-effects model in the Review Manager 5.4. We included 6 studies reporting data for 19,811 patients. The pooled analysis demonstrated that IO access had significantly higher odds of successful vascular access on first attempt [odds ratio (OR), 1.25; 95% confidence interval (CI), 0.19-0.34], but this did not translate to improved survival to hospital discharge (OR, 1.23; 95% CI, 0.90-1.67), survival to hospital discharge with a favorable neurological outcome (OR, 1.28; 95% CI, 0.93-1.76), and return of spontaneous circulation (OR, 1.13; 95% CI, 0.67-1.93). Intravenous and intraosseous vascular access have similar effects on clinical outcomes in patients with OHCA. The preferred method for vascular access should depend on the responder's feasibility and expertise.
AB - Establishing vascular access early in out-of-hospital cardiac arrest (OHCA) is a crucial factor for improving prognosis. Clinical guidelines recommend both intravascular (IV) and intraosseous (IO) access, but the superiority of one technique over the other has yet to be determined. Our review aimed to compare the efficacy and safety of IV versus IO access in OHCA. A comprehensive search was conducted on PubMed/MEDLINE, Embase, and Cochrane Library from inception till January 2025 for randomized controlled trials or their subgroup analyses comparing IV versus IO access in adult OHCA patients. The data for clinical outcomes were extracted, and forest plots were generated using the random-effects model in the Review Manager 5.4. We included 6 studies reporting data for 19,811 patients. The pooled analysis demonstrated that IO access had significantly higher odds of successful vascular access on first attempt [odds ratio (OR), 1.25; 95% confidence interval (CI), 0.19-0.34], but this did not translate to improved survival to hospital discharge (OR, 1.23; 95% CI, 0.90-1.67), survival to hospital discharge with a favorable neurological outcome (OR, 1.28; 95% CI, 0.93-1.76), and return of spontaneous circulation (OR, 1.13; 95% CI, 0.67-1.93). Intravenous and intraosseous vascular access have similar effects on clinical outcomes in patients with OHCA. The preferred method for vascular access should depend on the responder's feasibility and expertise.
KW - intraosseous
KW - intravenous
KW - out-of-hospital cardiac arrest
KW - return of spontaneous circulation
UR - https://www.scopus.com/pages/publications/105007359149
UR - https://www.scopus.com/pages/publications/105007359149#tab=citedBy
U2 - 10.1097/CRD.0000000000000966
DO - 10.1097/CRD.0000000000000966
M3 - Article
C2 - 40454813
AN - SCOPUS:105007359149
SN - 1061-5377
JO - Cardiology in review
JF - Cardiology in review
M1 - 10.1097/CRD.0000000000000966
ER -