Access in Out-Of-Hospital Cardiac Arrest (OHCA): Which is Best? IV or IO?

A patient with no access had a cardiac arrest in the field, aka OHCA (outside of hospital cardiac arrest).
Our trusty EMS (emergency medical services) teams who we all really appreciate show up at the scene.
Access to administer life-saving medications need to be obtained.
Should they attempt to obtain IV (intravenous) access?
Or should they attempt to obtain IO (intraosseous) access?
There was a recent summary of the current evidence published this month in Resuscitation.
Hat tip to the authors. Read these data for yourself as this is not medical advice.
It’s free for you to download.
Unfortunately, the optimal route is still not yet known.
It’s challenging to tease out the right answer as there have been no randomized controlled trials comparing IO to IV access in outside of hospital cardiac arrest.
We can subgroup it further and study if humeral is superior to tibial or vice versa.
Most trials have been observational.
Thankfully, there seem to be 5 RCT’s in the works to answer these questions.
My personal opinion is to obtain the fastest access one could obtain but I would love to hear directly from the boots on the ground as to what they think is best given the state of the data.
Should we give our cardiac arrest patients glucocorticoids?

Citation for Access in OHCA

Hooper A, Nolan JP, Rees N, Walker A, Perkins GD, Couper K. Drug routes in out-of-hospital cardiac arrest: A summary of current evidence. Resuscitation. 2022 Dec;181:70-78. doi: 10.1016/j.resuscitation.2022.10.015. Epub 2022 Oct 26. PMID: 36309248.
Link to Article

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