Abstract
Aim
To perform a systematic review of the literature on intravenous (IV) vs. intraosseous
(IO) administration of drugs during cardiac arrest in order to inform an update of
international guidelines.
Methods
The review was performed according to PRISMA guidelines and registered on PROSPERO.
Medline, Embase and Evidence-Based Medicine Reviews were searched on December 17,
2019 for studies comparing IV to IO administration of drugs. The population included
neonatal, paediatric, and adult patients with cardiac arrest. Two investigators reviewed
each search for study relevance, extracted data, and assessed the risk of bias of
individual studies. Meta-analyses were performed for studies without a critical risk
of bias. Certainty of evidence was evaluated using GRADE.
Results
We included six observational studies comparing IV to IO administration of drugs and
two randomized trials assessing the effect of specific drugs in subgroups related
to IV vs. IO administration. All studies included adult out-of-hospital cardiac arrest
patients. No studies were identified in neonatal or paediatric patients. The risk
of bias for the observational studies was overall assessed as critical or serious,
with confounding and selection bias being the primary sources of bias. The meta-analyses
excluding studies with a critical risk of bias favoured IV access for all outcomes.
Using GRADE, the certainty of evidence was judged at very low. Subgroup analyses of
the two randomized trials demonstrated no statistically significant interactions between
the route of access and study drugs on outcomes. However, these trials were underpowered
to assess such interactions.
Conclusions
We identified a limited number of studies comparing IV vs. IO administration of drugs
during cardiac arrest. Pooled results from four observational studies favoured IV
access with very low certainty of evidence. From the subgroup analyses of two randomized
clinical trials, there was no statistically significant interaction between the route
of access and study drug on outcomes.
Keywords
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Article info
Publication history
Published online: March 03, 2020
Accepted:
February 19,
2020
Received in revised form:
February 12,
2020
Received:
January 24,
2020
Footnotes
The members of the International Liaison Committee on Resuscitation’s (ILCOR) Neonatal Life Support, Paediatric Life Support, and Advanced Life Support Task Forces are listed at the end of the article.
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
