Is the intraosseous access route fast and efficacious compared to conventional central venous catheterization in adult patients under resuscitation in the emergency department? A prospective observational pilot study

Abstract

Background: For patients' safety reasons, current American Heart Association and European Resuscitation Council guidelines recommend intraosseous (IO) vascular access as an alternative in cases of emergency, if prompt venous catheterization is impossible. The purpose of this study was to compare the IO access as a bridging procedure versus central venous catheterization (CVC) for in-hospital adult emergency patients under resuscitation with impossible peripheral intravenous (IV) access. We hypothesised, that CVC is faster and more efficacious compared to IO access. Methods: A prospective observational study comparing success rates and procedure times of IO access (EZ-IO, Vidacare Corporation) versus CVC in adult (≥18 years of age) patients under trauma and medical resuscitation admitted to our emergency department with impossible peripheral IV catheterization was conducted. Procedure time was defined from preparation and insertion of vascular access type until first drug or infusion solution administration. Success rate on first attempt and procedure time for each access route was evaluated and statistically tested. Results: Ten consecutive adult patients under resuscitation, each receiving IO access and CVC, were analyzed. IO access was performed with 10 tibial or humeral insertions, CVC in 10 internal jugular or subclavian veins. The success rate on first attempt was 90% for IO insertion versus 60% for CVC. Mean procedure time was significantly lower for IO cannulation (2.3 min ± 0.8) compared to CVC (9.9 min ± 3.7) (p < 0.001). As for complications, failure of IO access was observed in one patient, while two or more attempts of CVC were necessary in four patients. No other relevant complications, like infection, bleeding or pneumothorax were observed. Conclusion: Preliminary data demonstrate that IO access is a reliable bridging method to gain vascular access for in-hospital adult emergency patients under trauma or medical resuscitation with impossible peripheral IV access. Furthermore, IO cannulation requires significantly less time to enable administration of drugs or infusion solutions compared to CVC. Because CVC was slower and less efficacious, IO access may improve the safety of adult patients under resuscitation in the emergency department.

Use of intraosseous devices in trauma: a survey of trauma practitioners in Canada, Australia and New Zealand

“…1,8,9 Furthermore, prospective studies have demonstrated superior speed of insertion with IO devices compared with the central venous catheter, which is generally considered the back-up technique for failed peripheral IV attempts. 10,11 Although the use of IO devices is rapidly expanding for patients requiring fluid and cardiac resuscitation, 1,9 some have expressed concern about their safety, especially in the setting of blood product transfusion. 12 Despite these concerns, the European Resuscitation Council Guidelines, 13 the American Heart Association Advanced Cardiac Life Support (ACLS) 14 and the American College of Surgeons Advanced Trauma Life Support (ATLS) 15 all support the use of IO devices for adult patients in extremis.…”

The Efficacy of Intraosseous Blood and Ringer Lactate in a Rabbit Model of Hemorrhagic Hypovolemia

“…Success rates of central venous canulation and IO access were compared in 10 trauma patients on whom peripheral vascular access could not be achieved after three attempts for a maximum of two minutes; first attempt success rate was 90% for IO access and 60% for central venous access. Mean procedure time was significantly shorter for IO cannulation ( 2.3 min) compared to central line placement (9.9 min) [13] . We preferred to use EZ -IO device in our study due to its easy application.…”

The versatility of intraosseous vascular access in perioperative medicine: a case series

“…Delayed treatment for these patients due to insufficient vascular access can lead to increased mortality. Several studies have demonstrated that intraosseous lines can be placed significantly faster than central lines [17,18]. Therefore, intraosseous assess should be considered by RRTs or critical care physicians when patients lacking appropriate vascular access begin to clinically deteriorate.…”