ArticleResuscitation plus2026
IntraVenous vs IntraOsseous access in Cardiac Arrest: the omitted economic question (IVOCA study).
Article in Resuscitation plus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
9 authors.
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No grant is acknowledged in the PubMed record.
Abstract
Aims: Intraosseous (IO) access is increasingly used during out-of-hospital cardiac arrest (OHCA) despite higher device costs and no proven clinical superiority over peripheral intravenous (IV) access. We conducted a cost-minimization analysis to estimate device-related costs under observed current practice and hypothetical alternative IV/IO strategies. Methods: Retrospective cohort study using regional data from the French national OHCA registry (RéAC), 2013-2024 (Seine-Saint-Denis, France). Patients receiving adrenaline (epinephrine) via IV or IO were included. Unit costs were €0.6 per IV catheter and €109 per IO needle. Scenario modeling was used to estimate device costs for alternative strategies (first-line IO versus stepwise IV-to-IO), using cumulative IV success rates (65% after one attempt to 99% after four), assuming 100% IO success, and applied to median annual registry volumes. Results: Among 10,737 OHCAs, 5350 (50%) patients were included (median age 62 years; 30% women). Access was IV only in 4128 (77%), IO only in 1092 (20%), and both in 130 (2%). Annual IO device costs increased from €5450 in 2013 to a peak of €16,350 in 2022, totaling €133,198 versus €2555 for IV. Return of spontaneous circulation (ROSC) occurred in 31% of cases (-0.3% annual decline); 30-day survival was 2.8% (-0.08% annual decline). Scenario modeling indicated that systematic first-line IO would correspond to €349 per ROSC and €3974 per survivor in device costs, whereas a strategy without IO would correspond to €2 per ROSC and €22 per survivor. Conclusion: Over the study period, IO use increased and generated substantially higher device costs. In the absence of proven clinical superiority, an IV-first strategy with selective IO use appears economically preferable.
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