Emergency intraosseous access in a helicopter emergency medical service: a retrospective study

Abstract

BackgroundIntraosseous access (IO) is a method for providing vascular access in out-of-hospital resuscitation of critically ill and injured patients when traditional intravenous access is difficult or impossible. Different intraosseous techniques have been used by our Helicopter Emergency Medical Services (HEMS) since 2003. Few articles document IO use by HEMS physicians. The aim of this study was to evaluate the use of intraosseous access in pre-hospital emergency situations handled by our HEMS.MethodsWe reviewed all medical records from the period May 2003 to April 2010, and compared three different techniques: Bone Injection Gun (B.I.G® - Waismed), manual bone marrow aspiration needle (Inter V - Medical Device Technologies) and EZ-IO® (Vidacare), used on both adults and paediatric patients.ResultsDuring this seven-year period, 78 insertion attempts were made on 70 patients. Overall success rates were 50% using the manual needle, 55% using the Bone Injection Gun, and 96% using the EZ-IO®. Rates of success on first attempt were significantly higher using the EZ-IO® compared to the manual needle/Bone Injection Gun (p < 0.01/p < 0.001). Fifteen failures were due to insertion-related problems (19.2%), with four technical problems (5.1%) and three extravasations (3.8%) being the most frequent causes. Intraosseous access was primarily used in connection with 53 patients in cardiac arrest (75.7%), including traumatic arrest, drowning and SIDS. Other diagnoses were seven patients with multi-trauma (10.0%), five with seizures/epilepsy (7.1%), three with respiratory failure (4.3%) and two others (2.9%). Nearly one third of all insertions (n = 22) were made in patients younger than two years. No cases of osteomyelitis or other serious complications were documented on the follow-up.ConclusionsNewer intraosseous techniques may enable faster and more reliable vascular access, and this can lower the threshold for intraosseous access on both adult and paediatric patients in critical situations. We believe that all emergency services that handle critically ill or injured paediatric and adult patients should be familiar with intraosseous techniques.

Four years of EZ-IO® system in the preand in-hospital emergency setting

“…The overall success rate of IOA procedures in our analysis was 98.8%. These results are comparable with several other previously published investigations ( [4]: 87%, [2]: 96%, [7]: 97%). Moreover, the 1 st attempt success rate in our investigation with 94% is in line with other data concern- [5]: 32 seconds compared with manual Cook needles).…”

“…Several authors have shown that the EZ-IO ® system is an efficient tool for achieving IOA [1][2][3][4][5]. The overall success rate of IOA procedures in our analysis was 98.8%.…”

“…It is reported to be a safe, simple and effective alternative to the intravenous access (IVA) and is described to be associated with a low rate of complications. The semiautomatic EZ-IO ® system is a fast and efficient method to establish an IOA [1][2][3][4][5]. The current published guidelines of the European Resuscitation Council (ERC) on cardiopulmonary resuscitation (CPR) recommend the intraosseous route when intravenous access cannot be achieved within the first two minutes of resuscitation [6].…”

Characteristics of Children Who Undergo Intraosseous Needle Placement

“…Dr. Tocantins, a professor of medicine who conducted a series of animal studies examining IO infusions, explored the concept of IO infusions further. After completing a number of rabbit studies examining various fluids, such as dextrose, blood, and saline, he went on to report the successful IO infusions in nine pediatric patients with "impossible" intravenous access (De Sá, Melo, Dantas, & Delfim, 2012;Drinker, Drinker, & Lund, 1922;Luck, Haines, & Mull, 2010;Tocantins, 1940;Tocantins, O'Neill, & Jones, 1941). With the development of intravenous catheters, the IO needle was replaced as the favored instrument for vascular access.…”

Lessons learned from the casualties of war: battlefield medicine and its implication for global trauma care

“…20 Intraosseous needles are now standard practice for trauma care in high-income countries for use in severe trauma, normally road traffic accidents, as a direct response to its proven military success. 21 The relative ease of training and placement make them an attractive proposition for use by paramedical staff and community health workers who are often the first to provide care in low-middle-income settings.…”