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Intraosseous access in adults in cardiac arrest: a systematic review and meta-analysis

Ignacio Morales-Cané1, María Del Rocío Valverde-León1, María Aurora Rodríguez-Borrego1

  • 1Instituto Maimónides de Investigación Biomédica de Córdoba, España.

Emergencias : Revista De La Sociedad Espanola De Medicina De Emergencias
|January 8, 2020
PubMed

Insights

Intraosseous access during out-of-hospital cardiac arrest is linked to lower return of spontaneous circulation (ROSC) and survival rates. This finding suggests venous access may be a more effective route for emergency interventions in these critical situations.

Area of Science:

  • Emergency Medicine
  • Critical Care
  • Cardiovascular Research

Background:

  • Out-of-hospital cardiac arrest (OHCA) presents significant survival challenges.
  • Intraosseous (IO) and intravenous (IV) access are critical for emergency medication and fluid delivery during resuscitation.
  • Evaluating the comparative efficacy of IO versus IV access in OHCA is crucial for optimizing patient outcomes.

Purpose of the Study:

  • To compare the effectiveness of intraosseous (IO) access versus venous (IV) access in adult patients experiencing out-of-hospital cardiac arrest (OHCA).
  • To assess the impact of IO versus IV access on return of spontaneous circulation (ROSC) and survival to hospital discharge.
  • To analyze neurological status at hospital discharge as a secondary outcome measure.

Main Methods:

  • A systematic review and meta-analysis of observational studies and clinical trials.
  • Searches conducted across MEDLINE, Embase, Web of Science, and Cochrane Library databases.
  • Included studies published from 1950 to 2019 involving adult OHCA patients with IO or IV catheter insertion; risk of bias assessed using Cochrane and GRADE tools.

Main Results:

  • Five studies were included in the meta-analysis from 434 identified papers.
  • Intraosseous access was associated with a significantly lower rate of return of spontaneous circulation (ROSC) (OR, 0.69; 95% CI, 0.57-0.83; P=.02).
  • Intraosseous access also correlated with worse survival to hospital discharge (OR, 0.65; 95% CI, 0.51-0.83; P<.01).

Conclusions:

  • Intraosseous access in the context of out-of-hospital cardiac arrest is associated with poorer patient outcomes.
  • These outcomes include reduced rates of ROSC and survival to hospital discharge compared to venous access.
  • Findings suggest a need to reconsider the routine use of intraosseous access in OHCA resuscitation protocols.
Abstract

Keywords:
Circulación espontáneaAlta hospitalariaHospital dischargeIntraosseous catheterSpontaneous circulationVía intraósea

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