Intraosseous Vascular Access in Cardiac Arrest: A Systematic Review of the Literature, with Implications for Future Research

AbstractPurpose of ReviewDespite recent advances, the rate of survival from out of hospital cardiac arrest (OHCA) in the USA remains low, at 10.4%. Intraosseous (IO) cannulation is described in the 2020 American Heart Association (AHA) Advanced Cardiac Life Support (ACLS) guidelines as an acceptable alternative to direct intravenous access for the administration of resuscitative fluids and medications to treat cardiac arrest (CA). Although IO vascular access is commonly used to treat CA, evidence on the efficacy of this route remains limited. The purpose of this review was to present the current evidence regarding the use of the IO route for the administration of resuscitative fluids and medications to treat OHCA so clinicians may then better identify gaps in the current knowledge base.Recent FindingsA total of 136 publications met all inclusion criteria and were included in the analysis. Six broad themes were identified among the included manuscripts: IO epinephrine infusion, IO infusion of other drugs, point of care IO blood sample analysis, animal models, observational studies (including case reports and series), and interventional human trials.SummaryMost data regarding the clinical efficacy of IO-delivered medication following OHCA are derived from laboratory-based animal studies. Prospective research pertaining to human subjects is primarily focused upon IO placement success, with little attention to clinical outcomes and inadequate granularity. Additional prospective s...
Source: Current Emergency and Hospital Medicine Reports - Category: Emergency Medicine Source Type: research