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The following is a summary of “Intraosseous versus intravenous vascular access in out-of-hospital cardiac arrest: a systematic review and meta-analysis of randomized controlled trials,” published in the March 2025 issue of Critical Care by Alilou et al. 

Researchers conducted a retrospective study to compare the effectiveness of intraosseous (IO) and intravenous (IV) access on outcomes in out-of-hospital cardiac arrest (OHCA).  

They performed a search in PubMed, Embase, and ClinicalTrials.gov for randomized controlled trials (RCTs) comparing IO and IV access in adults with OHCA. The primary outcome was survival at 30 days or until discharge and secondary outcomes included sustained return of spontaneous circulation (ROSC), favorable neurological outcome, successful first-attempt vascular access, and time from emergency medical service arrival to access. Pooled odds ratios (OR), mean differences (MD), and 95% confidence intervals (CI) were calculated for analysis.  

The results showed that 4 RCTs with 9,475 individuals were analyzed. Survival rates were similar between IO and IV groups (6.6% vs 6.9%, OR 0.99, 95% CI 0.84–1.18), as were favorable neurological outcomes (4.7% vs 4.6%, OR 1.07, 95% CI 0.88–1.30). Sustained ROSC was lower with IO access compared to IV (24.6% vs 27.0%, OR 0.92, 95% CI 0.80–1.06), though not statistically significant, IO access had a higher first-attempt success rate (92.3% vs 62.3%, OR 6.18, 95% CI 3.50–10.91) and achieved vascular access 15 seconds faster than IV (IO: 11.03 ± 5.57 min, IV: 11.35 ± 6.16 min, (MD − 0.25, 95% CI − 0.48 to − 0.01).  

Investigators concluded that IO access offered advantages in speed and first-attempt success over IV access and did not improved survival or neurological outcomes in adults with OHCA. 

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-025-05362-2