Comparative Safety and Efficacy of Four Intraosseous Devices for Vascular Access in the Emergency Department: A Systematic Review and Network Meta-Analysis

• Published in: The Journal of emergency medicine Vol. 76; pp. 64 - 78
• Main Authors: Suman, Swati, Mishra, Prakash Ranjan, Mishra, Paulina, Pandey, Shivam
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2025
• Subjects: efficacy; Emergency; emergency department; Emergency Service, Hospital - organization & administration; Emergency Service, Hospital - statistics & numerical data; Equipment Design - standards; Humans; Infusions, Intraosseous - instrumentation; Infusions, Intraosseous - methods; Infusions, Intraosseous - standards; intraosseous devices; network meta-analysis; resuscitation; safety; systematic review; vascular access; Vascular Access Devices - adverse effects; Vascular Access Devices - standards; safety; resuscitation; emergency department; network meta-analysis; systematic review; efficacy; intraosseous devices; vascular access
• ISSN: 0736-4679
• DOI: 10.1016/j.jemermed.2025.07.011

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. 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. 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. 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. This meta-analysis provides insights that, although battery-powered drill device showed the best outcomes, the wide confidence intervals and lack of statistically significant differences between devices highlight the need for further research with larger sample sizes and standardized safety reporting protocols, to establish conclusions regarding optimal IO device for EDs. What are the comparative safety and efficacy profiles of four different intraosseous devices, that is, battery-powered drill device, automatic device, semi-automatic spring-loaded device, and manual device, used for vascular access during resuscitation in the ED? PROSPERO No.: CRD42024602219, url: https://www.crd.york.ac.uk/prospero/export_details_pdf.php.