Efficacy of intraosseous access for non-traumatic out-of-hospital cardiac arrest: A meta-analysis of randomised controlled trials and propensity-score matched studies

Introduction Intravenous (IV) and intraosseous (IO) routes are the primary options for vascular access for out-of-hospital cardiac arrest (OHCA). However, the optimal route for improving clinical outcomes remains uncertain. Materials and methods We searched the Web of Science, PubMed, EMBASE and Cochrane Library databases until December 1, 2024. We expressed outcome data as relative risk (RR) with 95% CIs. Subgroup analysis and meta-regression analysis were conducted to explore the sources of heterogeneity. Results 10 studies involving 39,951 patients were included. In RCTs, no significant differences were observed between IO and IV access in patients with OHCA regarding survival (RR 1.03; 95% CI, 0.88–1.21; P = 0.70; I 2 = 0%), favorable neurological outcomes, or return of spontaneous circulation (ROSC). In PSM studies, IO access was inversely associated with these outcomes. In the meta-regression analysis, adjustment for time interval from call to drug administration, male ratio, and shockable rhythm ratio could explain the heterogeneity. Conclusions The analysis of RCTs showed no significant association between types of vascular access and efficiency outcomes. However, IO access was inversely associated with the outcomes in PSM studies. Time interval to drug administration, sex ratio, and initial rhythm could be identified as potential sources of heterogeneity. Trial registration Our review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42023466889)