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Intraosseous vs Intravenous Access for Epinephrine in Pediatric Out-of-Hospital Cardiac Arrest
Masashi Okubo1, Sho Komukai2, Junichi Izawa3,4
1Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
JAMA Network Open
|June 25, 2025
Summary
In pediatric out-of-hospital cardiac arrest, intraosseous (IO) or intravenous (IV) epinephrine administration showed no significant difference in survival or return of spontaneous circulation. This finding supports using either IO or IV routes for epinephrine delivery in children.
Area of Science:
- Pediatric Emergency Medicine
- Cardiology
- Resuscitation Science
Background:
- Epinephrine is crucial for pediatric out-of-hospital cardiac arrest (OHCA).
- Intraosseous (IO) and intravenous (IV) routes are common for epinephrine administration.
- The optimal route for pediatric OHCA remains unclear.
Purpose of the Study:
- To evaluate the association between epinephrine administration route (IO vs. IV) and patient outcomes in pediatric OHCA.
- To compare survival to hospital discharge and prehospital return of spontaneous circulation (ROSC).
Main Methods:
- Retrospective cohort study of pediatric patients (<18 years) with OHCA.
- Data from the Resuscitation Outcomes Consortium Epidemiologic Registry (2011-2015).
- Inverse probability of treatment weighting (IPTW) used to control for confounders.
Main Results:
- No significant difference in survival to hospital discharge between IO and IV epinephrine groups (5.3% vs. 5.7%).
- No significant difference in prehospital ROSC between IO and IV epinephrine groups (14.4% vs. 21.7%).
- Study included 739 pediatric patients, with 72.4% receiving IO and 27.6% receiving IV epinephrine.
Conclusions:
- The route of epinephrine administration (IO or IV) was not associated with survival or ROSC in pediatric OHCA.
- Findings suggest either IO or IV route is acceptable for prehospital epinephrine delivery in children.
- Supports current clinical practice guidelines for epinephrine administration in pediatric emergencies.
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