{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:07:09Z","timestamp":1760058429709,"version":"build-2065373602"},"reference-count":27,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T00:00:00Z","timestamp":1743984000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Out-of-hospital cardiac arrest (OHCA) is a common manifestation of heart disease and a leading cause of death in western societies with an overall survival rate of 10%. Guidelines generally prefer the peripheral intravenous (IV) access as the first option for OHCA patients, leaving the intraosseous (IO) route for patients in which IV access is not feasible or unsuccessful. This systematic review will purely focus on the clinical differences between adrenaline administered via the IO route compared to the IV route and its effects on morbidity and mortality after OHCA. Materials and Methods: A multi-database (PubMed, Medline, Embase, and The Cochrane Library) was performed and was searched between the earliest date of each database and 16 February 2024. For data extraction, a structured checklist was used, including type of study, the number of patients, age, gender, Return of Spontaneous Circulation (ROSC), associated morbidity, mortality, neurological, and general outcome. Results: The initial literature search produced 1772 results. After screening for title and abstract, a total of nine studies were included in our systematic review. Of these studies, six were retrospective cohort studies, one prospective study, and two sub-analyses of previous randomized trials. Due to significant heterogeneity, a meta-analysis was not performed. Conclusions: In our systematic review we have found a small number of studies comparing IV and IO adrenaline administration during cardiac arrest. Due to significant heterogeneity, a meta-analysis was not performed and no firm conclusions could be drawn about which route of adrenalin administration leads to better outcomes.<\/jats:p>","DOI":"10.3390\/medicina61040680","type":"journal-article","created":{"date-parts":[[2025,4,10]],"date-time":"2025-04-10T08:46:20Z","timestamp":1744274780000},"page":"680","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of Intravenous Versus Intraosseous Adrenalin Administration on Morbidity and Mortality After Out-of-Hospital Cardiac Arrest: A Systematic Review"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6390-7692","authenticated-orcid":false,"given":"Sjaak","family":"Pouwels","sequence":"first","affiliation":[{"name":"Department of Surgery, Campus Detmold, Klinikum Lippe, Bielefeld University, 32756 Detmold, Germany"},{"name":"Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, 5022 GC Tilburg, The Netherlands"},{"name":"Department of Surgery, Marien Hospital Herne, University Hospital of Ruhr University Bochum, 44653 Herne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emschka","family":"Johannes","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University Hospital Brussels, 1090 Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan Pablo","family":"Scarano-Pereira","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.resuscitation.2017.06.014","article-title":"Intraosseous compared to intravenous drug resuscitation in out-of-hospital cardiac arrest","volume":"117","author":"Feinstein","year":"2017","journal-title":"Resuscitation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.resuscitation.2018.10.031","article-title":"Intraosseous versus intravenous access in patients with out-of-hospital cardiac arrest: Insights from the resuscitation outcomes consortium continuous chest compression trial","volume":"134","author":"Mody","year":"2019","journal-title":"Resuscitation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.resuscitation.2021.02.003","article-title":"European Resuscitation Council Guidelines 2021: Executive summary","volume":"161","author":"Perkins","year":"2021","journal-title":"Resuscitation"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S337","DOI":"10.1161\/CIR.0000000000000918","article-title":"Part 1: Executive Summary: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care","volume":"142","author":"Merchant","year":"2020","journal-title":"Circulation"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.resuscitation.2020.01.009","article-title":"Intravenous versus intraosseous adrenaline administration in out-of-hospital cardiac arrest: A retrospective cohort study","volume":"149","author":"Zhang","year":"2020","journal-title":"Resuscitation"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1016\/j.annemergmed.2017.11.015","article-title":"Intraosseous Vascular Access Is Associated With Lower Survival and Neurologic Recovery Among Patients With Out-of-Hospital Cardiac Arrest","volume":"71","author":"Kawano","year":"2018","journal-title":"Ann. Emerg. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.ajem.2016.10.052","article-title":"Intravenous vs. intraosseous access and return of spontaneous circulation during out of hospital cardiac arrest","volume":"35","author":"Clemency","year":"2017","journal-title":"Am. J. Emerg. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1007\/s00134-019-05920-7","article-title":"Intraosseous versus intravenous administration of adrenaline in patients with out-of-hospital cardiac arrest: A secondary analysis of the PARAMEDIC2 placebo-controlled trial","volume":"46","author":"Nolan","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.resuscitation.2020.02.025","article-title":"Intravenous vs. intraosseous administration of drugs during cardiac arrest: A systematic review","volume":"149","author":"Granfeldt","year":"2020","journal-title":"Resuscitation"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.resuscitation.2011.07.041","article-title":"Pharmacokinetics of intraosseous and central venous drug delivery during cardiopulmonary resuscitation","volume":"83","author":"Hoskins","year":"2012","journal-title":"Resuscitation"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2043","DOI":"10.1016\/j.ajem.2019.02.035","article-title":"Pharmacokinetic effects of endotracheal, intraosseous, and intravenous epinephrine in a swine model of traumatic cardiac arrest","volume":"37","author":"Burgert","year":"2019","journal-title":"Am. J. Emerg. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"253","DOI":"10.5055\/ajdm.2016.0247","article-title":"The effects of tibial intraosseous versus intravenous amiodarone administration in a hypovolemic cardiac arrest procine model","volume":"11","author":"Hampton","year":"2016","journal-title":"Am. J. Disaster Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/j.jss.2015.11.015","article-title":"Effects of intraosseous epinephrine in a cardiac arrest swine model","volume":"201","author":"Wong","year":"2016","journal-title":"J. Surg. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1007\/s10557-020-06952-8","article-title":"Intraosseous Versus Peripheral Intravenous Access During Out-of-Hospital Cardiac Arrest: A Comparison of 30-Day Survival and Neurological Outcome in the French National Registry","volume":"34","author":"Baert","year":"2020","journal-title":"Cardiovasc. Drugs Ther."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"b2700","DOI":"10.1136\/bmj.b2700","article-title":"The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: Explanation and elaboration","volume":"339","author":"Liberati","year":"2009","journal-title":"BMJ"},{"key":"ref_16","unstructured":"Wells, G.A., Shea, B., O\u2019Conell, D., Peterson, J., Welch, V., Losos, M., and Tugwell, P. (2011). The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomized Studies in Meta-Analysis, Ottawa Hospital Research Institute."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Altman, D. (1991). Practical Statistics for Medical Research, Chapman and Hal.","DOI":"10.1201\/9780429258589"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.amj.2019.02.005","article-title":"Effect of Intravenous Versus Intraosseous Access in Prehospital Cardiac Arrest","volume":"38","author":"Nguyen","year":"2019","journal-title":"Air Med. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.resuscitation.2020.11.019","article-title":"Clinical evaluation of intravenous alone versus intravenous or intraosseous access for treatment of out-of-hospital cardiac arrest","volume":"159","author":"Tan","year":"2021","journal-title":"Resuscitation"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"119","DOI":"10.5055\/ajdm.2016.0230","article-title":"Time to epinephrine in out-of-hospital cardiac arrest: A retrospective analysis of intraosseous versus intravenous access","volume":"11","author":"Ross","year":"2016","journal-title":"Am. J. Disaster Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/j.annemergmed.2011.07.020","article-title":"Intraosseous versus intravenous vascular access during out-of-hospital cardiac arrest: A randomized controlled trial","volume":"58","author":"Reades","year":"2011","journal-title":"Ann. Emerg. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.ajem.2007.03.024","article-title":"Does intraosseous equal intravenous? A pharmacokinetic study","volume":"26","author":"Kuhn","year":"2008","journal-title":"Am. J. Emerg. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1398","DOI":"10.1056\/NEJM196312262692603","article-title":"Cardiac output and other hemodynamic variables during external cardiac massage in man","volume":"269","author":"Delguercio","year":"1963","journal-title":"N. Engl. J. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1161\/01.CIR.69.4.822","article-title":"Mechanisms by which epinephrine augments cerebral and myocardial perfusion during cardiopulmonary resuscitation in dogs","volume":"69","author":"Michael","year":"1984","journal-title":"Circulation"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"243","DOI":"10.5055\/ajdm.2016.0246","article-title":"Effects of tibial and humerus intraosseous administration of epinephrine in a cardiac arrest swine model","volume":"11","author":"Beaumont","year":"2016","journal-title":"Am. J. Disaster Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1097\/MCC.0b013e3281532b64","article-title":"The impedance threshold valve for adult cardiopulmonary resuscitation: A review of the literature","volume":"13","author":"Pirracchio","year":"2007","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.resuscitation.2010.10.022","article-title":"Variation in out-of-hospital cardiac arrest resuscitation and transport practices in the Resuscitation Outcomes Consortium: ROC Epistry-Cardiac Arrest","volume":"82","author":"Zive","year":"2011","journal-title":"Resuscitation"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/4\/680\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:11:42Z","timestamp":1760029902000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/4\/680"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,7]]},"references-count":27,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["medicina61040680"],"URL":"https:\/\/doi.org\/10.3390\/medicina61040680","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2025,4,7]]}}}