Intravenous Versus Intraosseous Vascular Access in Out-of-Hospital Cardiac Arrest: A Meta-Analysis

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.