NEW research has shown that in paediatric out-of-hospital cardiac arrest, the route of epinephrine administration, whether intraosseous or intravenous, does not influence survival to hospital discharge.
Out-of-hospital cardiac arrest (OHCA) in children is a critical emergency that demands swift and effective intervention. Epinephrine administration is a cornerstone of paediatric resuscitation, but the best route for delivery—either intraosseous (IO) or intravenous (IV)—has remained uncertain. Determining whether the method of administration affects survival outcomes is vital for guiding emergency medical protocols and ensuring optimal care.
This retrospective cohort study analysed data from 739 children (median age 1 year) who experienced nontraumatic OHCA and were treated by emergency medical services across ten sites in the United States and Canada between 2011 and 2015. Of these, 535 patients (72.4%) received epinephrine via an IO route and 204 (27.6%) via an IV route. The study used propensity scores and inverse probability of treatment weighting to adjust for differences in patient demographics, cardiac arrest characteristics, and prehospital interventions. The primary outcome was survival to hospital discharge, while the secondary outcome was return of spontaneous circulation (ROSC) before hospital arrival. There was no significant difference in survival between the IO (5.3%) and IV (5.7%) groups (risk ratio 0.92; 95% CI, 0.41–2.07). Similarly, rates of prehospital ROSC were not significantly different (IO 14.4% vs IV 21.7%; risk ratio 0.66; 95% CI, 0.42–1.03).
These results indicate that either intraosseous or intravenous routes are acceptable for epinephrine administration in paediatric OHCA, supporting flexibility in emergency care protocols. Clinicians can focus on establishing the quickest and most reliable vascular access without concern for compromising survival outcomes based on the chosen route. This evidence may help streamline decision-making in high-pressure situations, particularly in settings where IV access is challenging. Future research should further explore other important outcomes, such as neurological status following resuscitation, and validate these findings in prospective studies to ensure the best possible care for children in cardiac arrest.
Reference
Okubo M et al. Intraosseous vs intravenous access for epinephrine in pediatric out-of-hospital cardiac arrest. JAMA Netw Open. 2025;8(6):e2517291.
