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Intraosseous versus intravenous vascular access during out-of-hospital cardiac arrest: a systematic review and
Mohamed Saad Rakab1, AlMothana Manasrah2, Mohamed Rifai3
1Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Insights
Intraosseous (IO) access during out-of-hospital cardiac arrest (OHCA) resuscitation was linked to worse survival and neurological outcomes compared to intravenous (IV) access. This highlights the need for optimized vascular access strategies in emergency care.
Area of Science:
- Emergency Medicine
- Cardiology
- Critical Care
Background:
- Out-of-hospital cardiac arrest (OHCA) presents a substantial global health challenge with persistently low survival rates.
- Despite advancements in resuscitation techniques, effective vascular access remains critical for improving patient outcomes.
Purpose of the Study:
- To systematically evaluate and compare the effectiveness of intraosseous (IO) versus intravenous (IV) vascular access for resuscitation in OHCA patients.
- To analyze the impact of different vascular access methods on survival and neurological outcomes.
Main Methods:
- A comprehensive systematic review and meta-analysis was conducted, pooling data from major scientific databases (PubMed, CENTRAL, Scopus, Web of Science).
- Data were collected up to August 2024, and risk ratios (RR) with 95% confidence intervals (CI) were calculated for various resuscitation outcomes.
Main Results:
- The analysis included 21 studies encompassing 249,138 patients.
- Intraosseous (IO) access was significantly associated with reduced survival to admission (RR: 0.80) and discharge (RR: 0.52) compared to intravenous (IV) access.
- Furthermore, IO access showed lower likelihood of return of spontaneous circulation (RR: 0.77) and poorer neurological outcomes (RR: 0.55), despite a higher successful placement rate (RR: 1.59).
Conclusions:
- Intraosseous (IO) vascular access in OHCA resuscitation is associated with inferior survival and neurological outcomes when compared to intravenous (IV) access.
- Further research is imperative to refine and optimize vascular access strategies within emergency medical services to enhance patient survival and recovery.
Background:
Out-of-hospital cardiac arrest (OHCA) is a significant global healthcare burden, with survival rates remaining alarmingly low despite resuscitation advancements. This study aimed to evaluate the effect of intraosseous (IO) versus intravenous (IV) access for resuscitation on outcomes in OHCA.
Methods:
This systematic review and meta-analysis pooled data from studies retrieved from PubMed, CENTRAL, Scopus, and Web of Science up to August 2024. Risk ratios (RR) with 95% confidence intervals (CI) were calculated for all outcomes.
Results:
Twenty-one studies with a total of 249,138 patients were included. Compared to IV access, IO access was significantly associated with lower survival to admission (RR: 0.80, 95% CI [0.70, 0.90], P < 0.01), survival to discharge (RR: 0.52, 95% CI [0.42, 0.64], P < 0.01), likelihood of return of spontaneous circulation (RR: 0.77, 95% CI [0.70, 0.83], P < 0.01), and poorer neurological outcomes (RR: 0.55, 95% CI [0.40, 0.75], P < 0.01). However, IO access was associated with a higher successful placement (RR: 1.59, 95% CI [1.15, 2.21], P < 0.01).
Conclusion:
IO access was associated with worse survival and neurological outcomes compared to IV access in OHCA resuscitation. Further research is needed to optimize vascular access strategies in emergency care.
