• Anna Drozd, Jacek Smereka, Krzysztof J Filipiak, Miłosz Jaguszewski, Jerzy R Ładny, Karol Bielski, Klaudiusz Nadolny, Kurt Ruetzler, and Łukasz Szarpak.
• Kardiol Pol. 2021 Mar 25; 79 (3): 277-286.

BackgroundObtaining vascular access is one of the key procedures performed in patients in emergency settings.AimsThe study was conducted as a meta‑analysis and a systematic review and aimed to address the following question: which intravascular access method should be used in patients with COVID‑19 when wearing full personal protective equipment (PPE)?MethodsWe performed a systematic search of PubMed, EMBASE, and CENTRAL databases for randomized controlled trials that compared intravascular access methods used by operators wearing full level C PPE. We evaluated procedure duration and the success rate of intraosseous and peripheral intravenous accesses.ResultsEight randomized controlled trials were included in quantitative synthesis. The use of PPE during intravascular access procedures had an impact on procedure duration in the case of intraosseous access (mean difference [MD], 11.69; 95% CI, 6.47-16.92; P <0.001), as well as reduced the success rate of intraosseous access by 0.8% and intravenous access by 10.1%. Under PPE conditions, intraosseous access, compared with peripheral intravenous access, offered a shorter procedure time (MD, -41.43; 95% CI, -62.36 to -24.47; P <0.001).ConclusionThis comprehensive meta‑analysis suggested that the use of PPE significantly extends the duration of intravascular procedures. However, under PPE conditions, operators were able to obtain intraosseous access in a shorter time and with a higher success rate than in the case of intravenous access.

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