The impact of intraosseous vs intravenous vascular access during resuscitation in out-of-hospital cardiac arrest: A comprehensive systematic review and meta-analysis

Background: Out-of-hospital cardiac arrest (OHCA) is a known cause of mortality worldwide, especially in Western countries. One of the various treatment strategies includes vascular access for the administration of lifesaving drugs such as epinephrine and lidocaine. While intravenous (IV) access is traditionally performed, recent studies have evaluated the use of intraosseous (IO) access as an alternative. Objective: To evaluate the efficacy of IV vs IO in improvement in patient outcomes with OHCA Methods: A comprehensive literature search was conducted across five databases to identify studies comparing IV access to IO access in patients with OHCA. Statistical analysis via the 'meta' package and a random effects model was used and subgrouping was performed across adjusted and unadjusted values. Results: Nineteen studies were included, with a total of 239,486 patients with OHCA (IV = 154,073; IO = 85,413). The incidence of return of spontaneous circulation (ROSC) was significantly lower in the IO group than in the IV group (OR = 0.71; 95 % CI: 0.65, 0.78; p < 0.01), which was consistent across unadjusted and adjusted values. Additionally, the IO group had lower survival rates at admission, at discharge and at 30 days. The IO group had poorer neurological outcomes (OR = 0.64; 95 % CI: 0.49, 0.84; p < 0.01). Conclusion: Our meta-analysis revealed the superiority of intravenous vascular access over intraosseous access in adult patients suffering from OHCA. However, further randomized trials are needed to confirm these results.