Intravenous or intraosseous vascular access in cardiac arrest: an individual participant data meta-analysis.
Mathias J Holmberg, Keith Couper, Lars W Andersen et al.
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In 30 seconds
This individual participant data meta-analysis combined two randomized trials comparing intraosseous-first with intravenous-first vascular access in 7561 patients with out-of-hospital cardiac arrest. There was no statistically significant difference in 30-day survival between strategies (odds ratio, 1.01; 95% confidence interval, 0.81-1.25). Favorable neurological outcome also did not differ significantly. Sustained return of spontaneous circulation had a point estimate favoring intravenous access, but the result was not statistically significant. Bayesian analyses indicated a high probability that any difference between strategies was small.
Key findings
- For 30-day survival, intraosseous versus intravenous access had an odds ratio of 1.01 (95% confidence interval, 0.81-1.25; moderate certainty).
- Favorable neurological outcome at 30 days or hospital discharge did not differ significantly (odds ratio, 1.08; 95% confidence interval, 0.83-1.41; low certainty).
- Sustained return of spontaneous circulation had a point estimate favoring intravenous access (odds ratio, 0.90; 95% confidence interval, 0.81-1.01), without statistical significance.
Why it matters
Vascular access is part of resuscitation for out-of-hospital cardiac arrest, and the choice of initial route may affect patient outcomes. These pooled randomized-trial data do not show a significant advantage for either intraosseous-first or intravenous-first access in survival or neurological outcome. The findings help frame the comparative evidence while retaining uncertainty, particularly for outcomes graded as low certainty.
What to keep in mind
The analysis included individual participant data from only two randomized trials; certainty was low for neurological outcome and sustained return of spontaneous circulation.