Comparative Safety and Efficacy of Four Intraosseous Devices for Vascular Access in the Emergency Department: A Systematic Review and Network Meta-Analysis
Abstract
BACKGROUND
Intraosseous (IO) devices are increasingly being utilized for rapid vascular access in emergency departments (ED) and other time-sensitive conditions where intravenous access is challenging. In spite of their growing use, there is a paucity of literature addressing their safety and efficacy profiles, and it is needed to guide their current status in clinical practice and policy.
OBJECTIVES
To compare the safety and efficacy of four different types of IO devices utilized in EDs: battery-powered drill, automatic, semi-automatic spring-loaded, and manual devices.
METHODS
A systematic review and network meta-analysis was conducted. Studies on human subjects (excluding neonates) requiring IO access were included. Risk of bias and network meta-analysis was performed, with risk ratios (RR) and 95% confidence intervals (CI) calculated. Pairwise analysis of studies and surface under cumulative ranking curve (SUCRA) ranking of all devices were done.
RESULTS
Ten studies (783 participants) were included. Battery-powered drill device (RR 1.30, 95% CI 1.10-1.54), followed by manual device (RR 1.27, 95% CI 0.99-1.62) and automatic device (RR 1.20, 95% CI 0.99-1.44), showed higher incidence of success rates when compared with semi-automatic spring-loaded device. The SUCRA ranking also showed the highest cumulative probability of battery-powered drill (RR 1.30, 95% CI 1.10-1.54). Safety data were pooled in a tabular form.
CONCLUSION
This meta-analysis provides insights that,…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 783 participants or records.
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