SynthesisMedicine2026
Comparing intraosseous versus intravenous access for resuscitation in out-of-hospital cardiac arrest: A systematic review and GRADE meta-analysis.
Synthesis in Medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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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
15 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundOut-of-hospital cardiac arrest, which poses a severe challenge due to high mortality rates in emergency cases, warrants the need for effective resuscitation measures. This meta-analysis evaluated survival outcomes for intraosseous (IO) versus intravenous (IV) drug administration.
methodsElectronic databases, including PubMed, Cochrane Central, and ScienceDirect, were searched from inception until September 2024. Risk ratios (RRs) and 95 % confidence intervals (CIs) were pooled using Review Manager version 5.4.1 under a random-effects model for dichotomous outcomes. The quality of the studies was evaluated using the Cochrane Risk of Bias tool (RoB 2.0) and Newcastle-Ottawa Scale. Certainty of evidence was assessed through the grading of recommendations, assessment, development, and evaluations assessment.
resultsThe quantitative analysis included 18 studies comprising a total sample size of 245,132 patients. IO route was associated with a significantly lower return of spontaneous circulation (RR = 0.77, 95% CI: [0.71-0.83]; P < .00001; I2 = 84%), sustained return of spontaneous circulation (RR = 0.87, 95% CI: [0.77-0.97]; P = .02; I2 = 53%) and favorable neurological outcomes at hospital discharge (RR = 0.58, 95% CI: [0.45-0.73]; P < .00001; I2 = 81%) compared to IV route. It also showed a significantly lower survival at hospital arrival (RR = 0.79; 95% CI: [0.72-0.86]; P < .00001; I2 = 49%) and at hospital discharge (RR = 0.59; 95% CI: [0.45-0.78]; P < .0002; I2 = 95%) and short-term survival (RR = 0.52; 95% CI: [0.32-0.86]; P = .010; I2 = 72%). No publication bias was detected.
conclusionThis meta-analysis showed that IV access is superior to IO in terms of favorable neurological outcomes and survival to hospital arrival and discharge in out-of-hospital cardiac arrest patients. This suggests that when feasible, the IV route should be preferred in emergency resuscitation protocols.
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