The Route to Survival: Intravenous or Intraosseous Access in Cardiac Arrest

Out-of-hospital cardiac arrest (OHCA) continues to be one of the major challenges in emergency cardiovascular care. Despite advances in cardiopulmonary resuscitation (CPR) and defibrillation, overall survival rates remain low worldwide. Current international guidelines recommend the establishment of intravenous (IV) access as the first-line route for drug administration, while intraosseous (IO) access is suggested as an alternative when IV access cannot be promptly achieved.^1,2 In this context, every minute counts, and establishing vascular access for drug delivery is often a race against time. However, a long-standing question still persists: does the route of administration – intravenous or intraosseous – truly impact outcomes?

In this issue of the International Journal of Cardiovascular Sciences, Cavalcante et al. present a comprehensive meta-analysis comparing IO and IV access in adults with OHCA. Pooling data from more than 9,000 patients across three major randomized clinical trials,^3-5 the authors demonstrate that both routes yield similar results in terms of survival, with favorable neurological outcomes, the return of spontaneous circulation (ROSC), and survival to hospital discharge.⁶ Moderate heterogeneity was limited to the ROSC outcome, likely due to differences in its definition among studies. Beyond this, the evidence is consistent in showing that time to drug delivery, rather than the route of administration, determines patient outcomes.⁶

[…]