Abstract
This meta-analysis compared the efficacy of intraosseous (IO) versus intravenous (IV) drug administration in out-of-hospital cardiac arrest (OHCA). We systematically searched Embase, Web of Science, PubMed, and Cochrane Library through September 20, 2024, for relevant studies. The primary outcome was favorable neurological outcome, with secondary outcomes, including survival to hospital discharge and return of spontaneous circulation (ROSC). Seventeen studies, including randomized controlled trials and observational studies, were included in the final analysis. Pooled results showed that IV access was associated with significantly better outcomes compared to IO access. Patients in the IV group had 1.73 times higher odds of favorable neurological outcomes (RR: 1.73, 95% CI: 1.32-2.27), 1.64 times higher odds of survival to hospital discharge (RR: 1.64, 95% CI: 1.27-2.12), and 1.27 times higher odds of ROSC (RR: 1.27, 95% CI: 1.16-1.40). However, significant heterogeneity was observed across studies for all outcomes. These findings suggest that IV access may be superior to IO access in improving outcomes for OHCA patients. However, the high heterogeneity and conflicting results from individual studies highlight the need for careful interpretation and further research. Factors such as ease of access, speed of establishment, and patient condition should also be considered when choosing between IV and IO routes during resuscitation. This meta-analysis underscores the importance of reassessing current guidelines and conducting more robust primary studies to optimize vascular access strategies in OHCA management.