In-Hospital Cardiac Arrest! No Access. Place an IV or an IO?

CODE BLUE! Run! Run! Arrive and the patient has no IV access. What should we do next? Place a peripheral IV or place an intraosseous access? Which will lead to better outcomes? These authors took a retrospective look at in-hospital cardiac arrest at one center. They looked at a total of 1039 patients when it was all said and done. 832 has peripheral IV’s. 207 had IO access. This took place at UAB. Hat tip to the authors. If the code team arrived and a peripheral IV hadn’t been placed (or numerous failed attempts), they stopped trying and just placed an IO.

Was there a difference in survival to hospital discharge?

No. 28.4% survived in the PIV group and 20.8% survived in the IO group. Might seem like PIV is better but this is not statistically significant.

What if the patient is obese? Is there a difference in survival to hospital discharge there?

No. Although one would think it’s easier to place an IO in an obese person than a PIV, this did not improve outcomes.

What other outcomes showed no difference?

There was no difference in survival with favorable neurologic status.

Was there any difference between IO or IV?

Peripheral IV’s had a notably shorter time to ROSC in both the whole population and the obese subgroup. In addition, ROSC occurred earlier in the ALCS protocols.

Confounders in the Study

It seems as if the PIV got epic 30 seconds faster than the IO group. Also, the authors didn’t have access to the location of IO placement.

What to do with these data on IO or IV access?

The authors state that perhaps there might be a “true physiologic difference” between PIV and IO. They state that “drug administration via an IO may result in inferior pharmacokinetics”. I am going to keep using IO’s understanding these potential limitations if I can obtain it first. If the nurses can get peripheral access before I get the IO, then we shall use that. Please read the paper (if you can’t your hands on it) for all the details.

I’m taking a look at trying YouTube Shorts, TikTok, and Instagram Reels to expand the reach of my content. Let’s see how this goes by taking Journal Club-ish onto that platform.

If you want to learn whether to cool someone who suffered a cardiac arrest, CLICK HERE.


Schwalbach KT, Yong SS, Chad Wade R, Barney J. Impact of intraosseous versus intravenous resuscitation during in-hospital cardiac arrest: A retrospective study. Resuscitation. 2021 Sep;166:7-13. doi: 10.1016/j.resuscitation.2021.07.005. Epub 2021 Jul 14. PMID: 34273470.
Link to Article (NOT FREE)

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