Efficacy of the EZ-IO® needle driver for out-of-hospital intraosseous access - a preliminary, observational, multicenter study

Abstract

BackgroundIntraosseous (IO) access represents a reliable alternative to intravenous vascular access and is explicitly recommended in the current guidelines of the European Resuscitation Council when intravenous access is difficult or impossible. We therefore aimed to study the efficacy of the intraosseous needle driver EZ-IO® in the prehospital setting.MethodsDuring a 24-month period, all cases of prehospital IO access using the EZ-IO® needle driver within three operational areas of emergency medical services were prospectively recorded by a standardized questionnaire that needed to be filled out by the rescuer immediately after the mission and sent to the primary investigator. We determined the rate of successful insertion of the IO needle, the time required, immediate procedure-related complications, the level of previous experience with IO access, and operator's subjective satisfaction with the device.Results77 IO needle insertions were performed in 69 adults and five infants and children by emergency physicians (n = 72 applications) and paramedics (n = 5 applications). Needle placement was successful at the first attempt in all but 2 adults (one patient with unrecognized total knee arthroplasty, one case of needle obstruction after placement). The majority of users (92%) were relative novices with less than five previous IO needle placements. Of 22 responsive patients, 18 reported pain upon fluid administration via the needle. The rescuers' subjective rating regarding handling of the device and ease of needle insertion, as described by means of an analogue scale (0 = entirely unsatisfied, 10 = most satisfied), provided a median score of 10 (range 1-10).ConclusionsThe EZ-IO® needle driver was an efficient alternative to establish immediate out-of-hospital vascular access. However, significant pain upon intramedullary infusion was observed in the majority of responsive patients.

Multivariate Analysis of Successful Intravenous Line Placement in the Prehospital Setting

“…Similar to our results, the results from a study of intraosseous (IO) line placement by prehospital providers did not suggest an impact of prior procedural experience on success of IO placement, with novice users achieving a high (92%) success rate. 21 If there is a baseline experience that impacts IV placement success, the paramedics in our study may have had prior lifetime experience that put them above the threshold at which recent experience does matter, as all were either employed full-time or working two part-time jobs. Our data may also reflect selection bias based on the paramedic's perceived likelihood of success, whereas the likelihood that an IV placement is attempted may be impacted by the perceived likelihood of success.…”

Intraosseous infusion in elective and emergency pediatric anesthesia

“…In a conscious patient, pain on puncture might become an issue [19][20][21]. The provider must distinguish between local periostal anesthesia and endostal medullary anesthesia.…”

Die intraossäre Punktion in der prähospitalen Notfallmedizin

“…Allerdings können jedoch patientenseitige Bedingungen vorliegen, die eine erfolgreiche Anwendung des Verfahrens einschränken. Bei folgenden Konstellationen sollte eine intraossäre Punktion nicht durchgeführt werden[18,19]: ▶ Knochenfraktur am oder proximal des Punktionsorts (Gefahr der Paravasatbildung) ▶ Gefäßverletzung proximal der Punktionsstelle (Gefahr der Paravasatbildung) ▶ Kompartmentsyndrom an der zu punktierenden Extremität▶ akute Infektionen an der Punktionsstelle ▶ vorausgegangene intraossäre Punktionsversuche an der gleichen Lokalität binnen der letzten 24-48 h (Gefahr der Paravasatbildung) ▶ einliegendes Osteosynthesematerial am Punktionsort (Unmög-lichkeit des Einbringens der intraossären Punktionskanüle) ▶ stadtgehabte Sternotomie (sternales intraossäres Punktionssystem, z. B. FAST1 ® ) Relative Kontraindikationen.…”