Intraosseous versus intravenous vascular access during out-of-hospital cardiac arrest: a systematic review and meta-analysis

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.