Supervisors info:
Μπροκαλάκη Ηρώ, Ομότιμη Καθηγήτρια, Τμήμα Νοσηλευτικής, ΕΚΠΑ
Φώτος Νικόλαος, Αναπληρωτής Καθηγητής, Τμήμα Νοσηλευτικής, ΕΚΠΑ
Γιακουμιδάκης Κωνσταντίνος, Αναπληρωτής Καθηγητής, Τμήμα Νοσηλευτικής, Ελληνικό Μεσογειακό Πανεπιστήμιο
Summary:
Introduction: Out-of-hospital cardiac arrest is a major cause of mortality worldwide.
The main concern is how to achieve the best outcomes for those patients, and this is a
reason why intraosseous infusion has become again an alternative route of infusion in
these patients, while its effectiveness is under investigation.
Objectives: To investigate the effectiveness of intraosseous infusion, in contrast to
intravenous infusion, in prehospital cardiac arrest events, via a systematic review of
literature.
Material and Methods: The international literature was searched through PubMed and
Scopus databases, until 10th of July 2024. The search was made using the following
keywords: «intraosseous», «intravenous», «pre-hospital», «out-of-hospital», «cardiac
arrest», «heart arrest». The inclusion criteria of this study were defined as follows: a)
research study, b) Greek or English language, c) non-experimental (conducted on
humans), d) adults >18 years old and e) non traumatic etiology of cardiac arrest. All
studies that did not meet the above criteria, where excluded from further evaluation.
Results: From the literature search, 63 studies from PubMed database and 4 from
Scopus emerged for further evaluation. The final sample of this systematic review,
based on the inclusion criteria, as defined, after removal of duplicates, was 12 studies.
The majority were cohort studies, within the region of America. There was a
considerable heterogeneity in the characteristics of intraosseous and intravenous
subgroups, as well as in the definition of «access route» by the researchers. This led to
heterogeneity in results, with some showing superiority of intravenous route, while
others showed non-statistically significant differences in outcomes between the two
routes of administration. However, the most recent published results, show nostatistically significant differences in outcomes, with the only meta-analysis that is
published, highlight a possible superiority of intraosseous route of access if time to
intervention is taken into account.
Conclusions: Intraosseous infusion in prehospital cardiac arrest appears to show no
statistically significant difference, when compared to intravenous infusion, in terms of
survival and good neurologic outcome. However, it is deemed necessary for further
research, by conducting more studies and ideally, randomized clinical trials.
Keywords:
Intraosseous, Intravenous, Prehospital, Out-of-hospital, Cardiac arrest, Heart arrest
