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Effects of Intravenous Versus Intraosseous Adrenalin Administration on Morbidity and Mortality After Out-of-Hospital
Sjaak Pouwels1,2,3, Emschka Johannes4, Juan Pablo Scarano-Pereira5
1Department of Surgery, Campus Detmold, Klinikum Lippe, Bielefeld University, 32756 Detmold, Germany.
Insights
This review compared intravenous (IV) versus intraosseous (IO) adrenaline for out-of-hospital cardiac arrest (OHCA). Limited studies and significant heterogeneity prevented firm conclusions on which route improves survival or outcomes.
Area of Science:
- Emergency Medicine
- Cardiology
- Pharmacology
Background:
- Out-of-hospital cardiac arrest (OHCA) is a critical medical emergency with a low survival rate.
- Intravenous (IV) access is preferred for medication delivery in OHCA, with intraosseous (IO) access as a secondary option.
- Adrenaline is a key medication used in cardiac arrest management.
Purpose of the Study:
- To systematically review and compare the clinical effects of adrenaline administered via IV versus IO routes in OHCA patients.
- To evaluate the impact of each administration route on patient morbidity and mortality.
Main Methods:
- A comprehensive multi-database search (PubMed, Medline, Embase, Cochrane Library) was conducted up to February 16, 2024.
- Nine studies were included: six retrospective cohort studies, one prospective study, and two sub-analyses.
- Data extraction focused on study type, patient demographics, Return of Spontaneous Circulation (ROSC), morbidity, mortality, and neurological outcomes.
Main Results:
- The initial search yielded 1772 results, with nine studies ultimately included in the review.
- Significant heterogeneity was observed across the included studies.
- A meta-analysis could not be performed due to this heterogeneity.
Conclusions:
- A limited number of studies directly compare IV and IO adrenaline administration in OHCA.
- The heterogeneity of existing research precludes drawing definitive conclusions about the superiority of either route.
- Further high-quality research is needed to determine optimal adrenaline administration in OHCA.
Abstract:
Background and Objectives: Out-of-hospital cardiac arrest (OHCA) is a common manifestation of heart disease and a leading cause of death in western societies with an overall survival rate of 10%. Guidelines generally prefer the peripheral intravenous (IV) access as the first option for OHCA patients, leaving the intraosseous (IO) route for patients in which IV access is not feasible or unsuccessful. This systematic review will purely focus on the clinical differences between adrenaline administered via the IO route compared to the IV route and its effects on morbidity and mortality after OHCA. Materials and Methods: A multi-database (PubMed, Medline, Embase, and The Cochrane Library) was performed and was searched between the earliest date of each database and 16 February 2024. For data extraction, a structured checklist was used, including type of study, the number of patients, age, gender, Return of Spontaneous Circulation (ROSC), associated morbidity, mortality, neurological, and general outcome. Results: The initial literature search produced 1772 results. After screening for title and abstract, a total of nine studies were included in our systematic review. Of these studies, six were retrospective cohort studies, one prospective study, and two sub-analyses of previous randomized trials. Due to significant heterogeneity, a meta-analysis was not performed. Conclusions: In our systematic review we have found a small number of studies comparing IV and IO adrenaline administration during cardiac arrest. Due to significant heterogeneity, a meta-analysis was not performed and no firm conclusions could be drawn about which route of adrenalin administration leads to better outcomes.
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