Intraosseous versus intravenous access in pre-hospital cardiac arrest: Systematic Review

Abstract

Out-of-hospital cardiac arrest is a significant cause of mortality worldwide. The main concern is how to achieve the best outcomes for those patients, and this is a reason why intraosseous infusion has become again an alternative route of infusion in these patients, while its effectiveness is under investigation. Objective: to investigate the efficacy of intraosseous infusion, in contrast to intravenous infusion, in prehospital cardiac arrest events, via a systematic review of literature. Material and Methods: The international literature was searched through MEDLINE database via PubMed online platform, and Scopus database, until the 10^th of July 2024. The search was made using the following keywords: «intraosseous», «intravenous», «pre-hospital», «out-of-hospital», «cardiac arrest», and «heart arrest». The inclusion criteria of this study were defined as follows: a) research study (randomized controlled trials, cohort studies, and retrospective studies using data from patient registries), b) Greek or English language, c) non-experimental (conducted on humans), d) adults >18 years old, and e) non-traumatic etiology of cardiac arrest. The manuscript is fully compliant with PRISMA guidelines Results: From the literature search, 63 studies from the PubMed database and 4 from Scopus emerged for further evaluation. The final sample of this systematic review, based on the inclusion criteria, as defined, after the removal of duplicates, was 12 studies. The majority were cohort studies, within the region of America. There was considerable heterogeneity in the characteristics of intraosseous and intravenous subgroups, as well as in the definition of «access route» by the researchers. This led to unclear results, with some showing the superiority of the intravenous route, while others showed non-statistically significant differences in outcomes between the two routes of administration. However, the most recent published results show no statistically significant differences in outcomes, with the only meta-analysis that is published, highlight a possible superiority of intraosseous route of access if time to intervention is considered. Conclusions: Intraosseous infusion in prehospital cardiac arrest appears to show no statistically significant difference, when compared to intravenous infusion, in terms of survival and good neurologic outcome. However, it is deemed necessary for further research,  by conducting more studies and ideally, randomized clinical trials.