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
Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK; Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
Resuscitation. 2025 Feb;207:110481. doi: 10.1016/j.resuscitation.2024.110481. Epub 2024 Dec 30.
To summarise evidence on the clinical effectiveness of initial vascular attempts via the intraosseous route compared to the intravenous route in adult cardiac arrest.
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.
We included three randomised clinical trials encompassing 9,332 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 0.99, 95% confidence interval 0.84-1.17; 9,272 participants; three trials; moderate-certainty evidence) or favourable neurological outcome at 30-days/ hospital discharge (odds ratio 1.07, 95% confidence interval 0.88-1.30; 9,186 participants; three 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; 7,518 participants; two trials; moderate-certainty evidence).
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.
总结在成人心脏骤停时，与静脉途径相比，经骨内途径进行初始血管穿刺尝试的临床有效性证据。
我们检索了MEDLINE和Embase（OVID平台）、Cochrane图书馆以及国际临床试验注册平台，检索时间从各数据库建库至2024年9月4日，以查找比较成人心脏骤停时经骨内途径与静脉途径的随机临床试验。我们的主要结局是30天生存率。次要结局包括30天/出院时良好的神经功能结局以及自主循环恢复（包括任何自主循环恢复和持续自主循环恢复）。我们使用固定效应模型进行荟萃分析。我们使用Cochrane偏倚风险-2工具评估偏倚风险，并使用GRADE方法评估证据确定性。
我们纳入了三项随机临床试验，共9332例院外心脏骤停患者。与静脉途径相比，经骨内途径进行初始尝试并未增加30天生存率（优势比0.99，95%置信区间0.84-1.17；9272例患者；三项试验；中等确定性证据）或30天/出院时良好的神经功能结局（优势比1.07，95%置信区间0.88-1.30；9186例患者；三项试验；低确定性证据）。经骨内组实现持续自主循环恢复的几率较低（优势比0.89，95%置信区间0.80-0.99；7518例患者；两项试验；中等确定性证据）。
在成人心脏骤停时，与静脉途径相比，经骨内途径进行初始血管通路尝试并未改善30天生存率，且可能降低持续自主循环恢复的几率。
