Intraosseous and Intravenous Epinephrine Administration Routes in Out‐of‐Hospital Cardiac Arrest: Survival and Neurologic Outcomes

Abstract

Background The rate of survival after out‐of‐hospital cardiac arrest varies depending on the timeliness and effectiveness of prehospital interventions. This study was conducted to compare out‐of‐hospital cardiac arrest outcomes between intravenous and intraosseous routes and between upper and lower extremity routes for drug administration. Methods and Results We retrospectively analyzed data (collected using the Utstein template) from 1220 patients who had experienced out‐of‐hospital cardiac arrest in Taiwan's Taoyuan City between January 2021 and August 2023. The patients were stratified into intravenous and intraosseous groups by treatment approach and upper and lower extremity access groups by access site. The study outcomes were survival to discharge, favorable neurologic outcomes (Cerebral Performance Category score 1 or 2), and survival for >2 hours. The study groups were statistically compared before and after propensity score matching. Significant pre–propensity score matching differences were observed between intravenous and intraosseous groups, and the aforementioned study outcomes were better in the intravenous group than in the intraosseous group. However, the between‐group differences became nonsignificant after propensity score matching. Furthermore, lower extremity access and delayed epinephrine administration were associated with worse outcomes. Survival rates fell below 12.6% when time to treatment exceeded 15 minutes, particularly in the cases of intraosseous access and lower extremity access. Conclusions This study highlights the benefits of early intervention and upper extremity access for drug administration in patients with out‐of‐hospital cardiac arrest. Intraosseous access may serve as a viable alternative to intravenous access. Timely administration of essential drugs during resuscitation can improve clinical outcomes and thus has implications for emergency medical service training.

Keywords

• automated external defibrillator
• cardiopulmonary resuscitation
• intraosseous
• intravenous
• out‐of‐hospital cardiac arrest