Intraosseous vs intravenous access: which is better during resuscitation?

Two randomized trials shed light on expanding use of IOs by EMTs

During cardiac arrest, every second matters (at least potentially). For out-of-hospital cardiac arrest in particular, intravenous access can be difficult to establish, delaying the administration of epinephrine and other drugs and possibly worsening outcomes.

Intraosseous (IO) devices—inserted by punching a needle loaded on a trocar into the tibia or femur—can be placed more easily than IV catheters, leading to faster injection of epinephrine.

On the other hand, infusion speed and distribution of epinephrine into the systemic circulation might be slower with intraosseous delivery.

Because of their ease of use, IO devices have been widely adopted by paramedics and in other prehospital settings, surpassing IV access as the first-line strategy in some geographic areas. This defies American and European guidelines advising IO access to be used only if IV access attempts fail.

Do EMTs know something the AHA doesn’t? Are intraosseous devices superior to peripheral IVs for vascular access during resuscitation attempts?

Two large randomized trials tested the use of intraosseous devices against intravenous catheters during the management of out-of-hospital cardiac arrest.