Intraosseous and intravenous vascular access during adult cardiac arrest: a systematic review and meta-analysis
Couper, Keith Andersen, Lars W Drennan, Ian R Grunau, Brian E Kudenchuk, Peter J Lall, Ranjit Lavonas, Eric J Perkins, Gavin D Vallentin, Mikael Fink Granfeldt, Asger
Couper, Keith
Andersen, Lars W
Drennan, Ian R
Grunau, Brian E
Kudenchuk, Peter J
Lall, Ranjit
Lavonas, Eric J
Perkins, Gavin D
Vallentin, Mikael Fink
Granfeldt, Asger
Abstract
Objective: To summarise evidence on the clinical effectiveness of initial vascular attempts via the intraosseous route compared to the intravenous route in adult cardiac arrest.
Methods: We searched MEDLINE and Embase (OVID platform), the Cochrane library, and the International Clinical Trials Registry Platform from inception to September 4th 2024 for randomised clinical trials comparing the intraosseous route with the intravenous route in adult cardiac arrest. Our primary outcome was 30-day survival. Secondary outcomes included favourable neurological outcome at 30-days/hospital discharge and return of spontaneous circulation (both any ROSC and sustained ROSC). We performed meta-analyses using a fixed-effect model. We assessed risk of bias using the Cochrane Risk of Bias-2 tool and evidence certainty using the GRADE approach.
Results: We originally included three randomised clinical trials, but one trial was subsequently retracted. As such, two trials were included encompassing 7561 participants with out-of-hospital cardiac arrest. Initial attempts via the intraosseous, compared with intravenous, route did not increase the odds of 30-day survival (odds ratio 0.97, 95% confidence interval 0.80-1.18; 7540 participants; two trials; moderate-certainty evidence) or favourable neurological outcome at 30-days/hospital discharge (odds ratio 1.03, 95% confidence interval 0.81-1.31; 7454 participants; two trials; low-certainty evidence). The odds of achieving sustained return of spontaneous circulation were lower in the intraosseous group (odds ratio 0.89, 95% confidence interval 0.80-0.99; 7518 participants; two trials; moderate-certainty evidence).
Conclusion: Initial vascular access attempts via the intraosseous, compared with intravenous, route in adult cardiac arrest did not improve 30-day survival and may reduce the odds of a sustained return of spontaneous circulation.
MIDER Authors
Date
2026-02-26
Type
Article
Subject
Heart arrest, Cardiopulmonary resuscitation, Epinephrine, Injections, intravenous
Collections
Citation
Couper K, Andersen LW, Drennan IR, Grunau BE, Kudenchuk PJ, Lall R, Lavonas EJ, Perkins GD, Vallentin MF, Granfeldt A; International Liaison Committee on Resuscitation Advanced Life Support Task Force. Intraosseous and intravenous vascular access during adult cardiac arrest: a systematic review and meta-analysis. Resuscitation. 2026 Feb 26:111015. doi: 10.1016/j.resuscitation.2026.111015. Epub ahead of print. Erratum for: Resuscitation. 2025 Feb;207:110481. doi: 10.1016/j.resuscitation.2024.110481.
Journal / Source Title
Resuscitation
DOI
10.1016/j.resuscitation.2026.111015
PMID
41760477
Publisher
Elsevier/north-Holland Biomedical Press
Publisher’s URL
https://www.sciencedirect.com/journal/resuscitation