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Intravenous Versus Intraosseous Administration of Drugs During Cardiac Arrest

Red Cross Guidelines

  • Intravenous (IV) access compared to intraosseous access is reasonable for the first attempt for vascular access during adult cardiac arrest. NEW

  • Intraosseous access may be considered as an alternative to IV access in emergency situations when IV access is unsuccessful within two attempts or is not feasible. UPDATED

 

Insights

During cardiac arrest, vascular access is critical for delivery of medications or fluids. Past guidelines for adults have recommended intravenous (IV) access first and intraosseous (IO) access when IV attempts fail or are not feasible. Recent trials comparing the IO route with the IV route failed to show a benefit for the IO route for survival at 30 days and other critical outcomes. Other studies showed reduced odds of achieving sustained return of spontaneous circulation with an initial IO approach compared with an initial IV approach. For some patients, however, IV access may not be feasible due to health-related factors that prohibit IV access or limited physical access to a patient. In these cases, initial IO access may be reasonable. The Red Cross guideline for considering IO access after two failed vascular access attempts is based on the protocols used in study trials and reflects an ILCOR good practice statement.