Saad Muhammad, Sohail Muhammad Umer, Waqas Saad Ahmed, Ansari Ifrah, Gupta Ashish, Jain Hritvik, Ahmed Raheel
Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Am J Emerg Med. 2025 May;91:100-103. doi: 10.1016/j.ajem.2025.02.029. Epub 2025 Feb 23.
Out-of-hospital cardiac arrest (OHCA) is a leading cause of global mortality. Timely drug administration via vascular access is critical, with intravenous (IV) and intraosseous (IO) routes being the primary options. Current guidelines prefer IV access but recommend IO when IV access is delayed. This systematic review and meta-analysis of randomized controlled trials (RCTs) evaluated the clinical effectiveness of IO compared to IV access in adults with OHCA.
A comprehensive search of PubMed, Scopus, and Cochrane databases through November 2024 identified RCTs comparing IO and IV drug administration in OHCA patients aged ≥18 years. Outcomes included 30-day survival, sustained return of spontaneous circulation (ROSC), survival to hospital discharge, and survival with favorable neurological outcomes. Pooled odds ratios (ORs) with 95 % confidence intervals (CIs) were calculated using a random-effects model.
Three RCTs comprising 9293 patients were included. No significant differences were found between IO and IV routes for 30-day survival (OR: 1.00, 95 % CI: 0.76-1.34, p = 0.98), sustained ROSC (OR: 1.08, 95 % CI: 0.97-1.21, p = 0.18), survival to hospital discharge (OR: 1.03, 95 % CI: 0.84-1.25, p = 0.80), or favorable neurological outcomes (OR: 0.93, 95 % CI: 0.77-1.13, p = 0.49).
IV and IO access routes demonstrated comparable outcomes for survival and neurological function in OHCA. These findings support the flexibility to prioritize the most practical route in emergency settings, particularly when IV access is delayed or challenging. Further research should explore patient-level outcomes and health economic implications.
院外心脏骤停（OHCA）是全球死亡的主要原因。通过血管通路及时给药至关重要，静脉注射（IV）和骨内注射（IO）是主要途径。当前指南更倾向于静脉通路，但在静脉通路延迟时推荐骨内注射。这项对随机对照试验（RCT）的系统评价和荟萃分析评估了在成年OHCA患者中，与静脉通路相比，骨内注射的临床效果。
全面检索截至2024年11月的PubMed、Scopus和Cochrane数据库，以确定比较≥18岁OHCA患者骨内注射和静脉给药的随机对照试验。结局包括30天生存率、自主循环持续恢复（ROSC）、出院生存率以及具有良好神经功能结局的生存率。使用随机效应模型计算合并比值比（OR）及其95%置信区间（CI）。
纳入了三项随机对照试验，共9293例患者。在30天生存率（OR：1.00，95%CI：0.76 - 1.34，p = 0.98）、自主循环持续恢复（OR：1.08，95%CI：0.97 - 1.21，p = 0.18）、出院生存率（OR：1.03，95%CI：0.84 - 1.25，p = 0.80）或良好神经功能结局（OR：0.93，95%CI：0.77 - 1.13，p = 0.49）方面，骨内注射和静脉注射途径之间未发现显著差异。
在院外心脏骤停中，静脉和骨内通路在生存和神经功能方面显示出相似的结局。这些发现支持在紧急情况下灵活选择最实用的通路，特别是在静脉通路延迟或困难时。进一步的研究应探索患者层面的结局和卫生经济影响。
