Intraosseous vs. intravenous access in out-of-hospital cardiac arrest: a systematic review and meta-analysis of clinical outcomes
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 of...
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BMC
2025-07-01
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| Series: | International Journal of Emergency Medicine |
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| Online Access: | https://doi.org/10.1186/s12245-025-00927-y |
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| author | Emmanuel Kokori Nawaf Al-Hashemi Ziad Sad Aldeen Ravi Patel Nicholas Aderinto Gbolahan Olatunji Iyanuloluwa S. Ojo Israel Charles Abraham Hafeez Shaka |
| author_facet | Emmanuel Kokori Nawaf Al-Hashemi Ziad Sad Aldeen Ravi Patel Nicholas Aderinto Gbolahan Olatunji Iyanuloluwa S. Ojo Israel Charles Abraham Hafeez Shaka |
| author_sort | Emmanuel Kokori |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-e3e26224722c47b191e6a46a75b7d711 |
| institution | Kabale University |
| issn | 1865-1380 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal of Emergency Medicine |
| spelling | doaj-art-e3e26224722c47b191e6a46a75b7d7112025-08-20T04:01:47ZengBMCInternational Journal of Emergency Medicine1865-13802025-07-0118111610.1186/s12245-025-00927-yIntraosseous vs. intravenous access in out-of-hospital cardiac arrest: a systematic review and meta-analysis of clinical outcomesEmmanuel Kokori0Nawaf Al-Hashemi1Ziad Sad Aldeen2Ravi Patel3Nicholas Aderinto4Gbolahan Olatunji5Iyanuloluwa S. Ojo6Israel Charles Abraham7Hafeez Shaka8Department of Medicine and Surgery, University of IlorinDepartment of Hospital Medicine, Atrium Navicent HospitalDepartment of Hospital Medicine, University of Wisconsin-MadisonDepartment of Internal Medicine, Methodist Health System DallasDepartment of Medicine and Surgery, Ladoke Akintola University of TechnologyJohns Hopkins Bloomberg School of Public HealthDepartment of Internal Medicine, University College HospitalDepartment of Medicine and Surgery, University of IlorinDivision of General Medicine, John H Stroger Jr Hospital of Cook CountyAbstract 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.https://doi.org/10.1186/s12245-025-00927-yIntraosseous accessIntravenous accessOut-of-hospital cardiac arrest (OHCA)Cardiac arrest resuscitationEmergency medical services (EMS) |
| spellingShingle | Emmanuel Kokori Nawaf Al-Hashemi Ziad Sad Aldeen Ravi Patel Nicholas Aderinto Gbolahan Olatunji Iyanuloluwa S. Ojo Israel Charles Abraham Hafeez Shaka Intraosseous vs. intravenous access in out-of-hospital cardiac arrest: a systematic review and meta-analysis of clinical outcomes International Journal of Emergency Medicine Intraosseous access Intravenous access Out-of-hospital cardiac arrest (OHCA) Cardiac arrest resuscitation Emergency medical services (EMS) |
| title | Intraosseous vs. intravenous access in out-of-hospital cardiac arrest: a systematic review and meta-analysis of clinical outcomes |
| title_full | Intraosseous vs. intravenous access in out-of-hospital cardiac arrest: a systematic review and meta-analysis of clinical outcomes |
| title_fullStr | Intraosseous vs. intravenous access in out-of-hospital cardiac arrest: a systematic review and meta-analysis of clinical outcomes |
| title_full_unstemmed | Intraosseous vs. intravenous access in out-of-hospital cardiac arrest: a systematic review and meta-analysis of clinical outcomes |
| title_short | Intraosseous vs. intravenous access in out-of-hospital cardiac arrest: a systematic review and meta-analysis of clinical outcomes |
| title_sort | intraosseous vs intravenous access in out of hospital cardiac arrest a systematic review and meta analysis of clinical outcomes |
| topic | Intraosseous access Intravenous access Out-of-hospital cardiac arrest (OHCA) Cardiac arrest resuscitation Emergency medical services (EMS) |
| url | https://doi.org/10.1186/s12245-025-00927-y |
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