The Role of Intraosseous Vascular Access in the Out-of-Hospital Environment (Resource Document to NAEMSP Position Statement)

Fowler, Raymond L.; Gallagher, John V.; Isaacs, S. Marshal; Ossman, Eric; Pepe, Paul E.; Wayne, Michael

doi:10.1080/10903120601021036

Cited by 99 publications

(54 citation statements)

References 21 publications

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“…IO administration may be an option and is already recommended as a second line of drug administration by the American Heart Association. 23,24 In its favor, IO catheter placement has been shown to have a high success rate, is simple, and is commonly practiced in the prehospital and hospital settings. 15,25,26 In addition to evaluating the efficacy of IO hydroxocobalamin, we used near infrared spectroscopy, which is a continuous noninvasive assessment of tissue perfusion and oxygen delivery in trauma care and hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Intraosseous Versus Intravenous Infusion of Hydroxocobalamin for the Treatment Of Acute Severe Cyanide Toxicity in a Swine Model

Bebarta

Pitotti

Boudreau

et al. 2014

Academic Emergency Medicine

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Objectives: Easily administrated cyanide antidotes are needed for first responders, military troops, and emergency department staff after cyanide exposure in mass casualty incidents or due to smoke inhalation during fires involving many victims. Hydroxocobalamin has proven to be an effective antidote, but cannot be given intramuscularly because the volume of diluent needed is too large. Thus, intraosseous (IO) infusion may be an alternative, as it is simple and has been recommended for the administration of other resuscitation drugs. The primary objective of this study was to compare the efficacy of IO delivery of hydroxocobalamin to intravenous (IV) injection for the management of acute cyanide toxicity in a well-described porcine model. Methods:Twenty-four swine (45 to 55 kg) were anesthetized, intubated, and instrumented with continuous mean arterial pressure (MAP) and cardiac output monitoring. Cyanide was continuously infused until severe hypotension (50% of baseline MAP), followed by IO or IV hydroxocobalamin treatment. Animals were randomly assigned to receive IV (150 mg/kg) or IO (150 mg/kg) hydroxocobalamin and monitored for 60 minutes after start of antidotal infusion. The primary outcome measure was the change in MAP after antidotal treatment from onset of hypotension (time zero) to 60 minutes. A sample size of 12 animals per group was determined by group size analysis based on power of 80% to detect a one standard deviation of the mean MAP between the groups with an alpha of 0.05. Whole blood cyanide, lactate, pH, nitrotyrosine (nitric oxide marker) levels, cerebral and renal near infrared spectrometry (NIRS) oxygenation, and inflammatory markers were also measured. Repeated-measures analysis of variance was used to determine statistically significant changes between groups over time.Results: At baseline and at the point of hypotension, physiologic parameters were similar between groups. At the conclusion of the study, 10 out of 12 animals in the IV group and 10 out of 12 in IO group survived (p = 1.0). Both groups demonstrated a similar return to baseline MAP (p = 0.997). Cardiac output, oxygen saturation, and systemic vascular resistance were also found to be similar between groups (p > 0.4), and no difference was detected between bicarbonate, pH, and lactate levels (p > 0.8). Cyanide levels were undetectable after the hydroxocobalamin infusion throughout the study in both groups (p = 1.0). Cerebral and renal NIRS oxygenation decreased in parallel to MAP during cyanide infusion and increased after antidote infusion in both groups. Serum nitrotyrosine increased during cyanide infusion in all animals and then decreased in both study arms after hydroxocobalamin infusion (p > 0.5). Serum cytokines increased starting at cyanide infusion and no difference was detected between groups (tumor necrosis factor-a, interleukin [IL]-1b, IL-6, and IL-10).

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Section: Discussionmentioning

confidence: 99%

Intraosseous Versus Intravenous Infusion of Hydroxocobalamin for the Treatment Of Acute Severe Cyanide Toxicity in a Swine Model

Bebarta

Pitotti

Boudreau

et al. 2014

Academic Emergency Medicine

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“…Finally, improved communication with young patients and their parents/caregivers is a critical factor in establishing realistic expectations and in achieving patient/parent satisfaction with the quality of medical care in the hospital and the ED. As effective as IV for fluid administration in nonemergency situations 46 Rates of fluid administration and drug absorption can be accelerated with hyaluronidase [47][48][49][50][51][52][53] Vein-sparing; fewer complications than with IV 46 Easy setup and maintenance 46,54 Cost-effective 46,54 Similar serum drug levels achieved with IO and IV 55 Access and drug delivery may be faster than with IV Risk of catheter dysfunction (eg, phlebitis, inadvertent dislodgement) 57 Risk of thrombosis 57 May take longer than other routes of venous access 56 Risk of thrombosis 56 Requires special skills that are difficult to maintain if the procedure is not done frequently Abbreviations: IV, intravenous; SC, subcutaneous; IO, intraosseous; CVC, central venous catheter.…”

Section: Discussionmentioning

confidence: 99%

“…57 In contrast to CVC insertion, IO infusion can be quickly learned. 55 It allows the rapid delivery of a variety of drugs, crystalloid solutions, and blood products in emergency and nonemergency situations. 55 IO procedures may take less time than IVs to achieve access and administer medications, but they are more costly and painful.…”

Section: Alternatives To IV Therapymentioning

confidence: 99%

“…55 It allows the rapid delivery of a variety of drugs, crystalloid solutions, and blood products in emergency and nonemergency situations. 55 IO procedures may take less time than IVs to achieve access and administer medications, but they are more costly and painful. 55 Complications are rare but increase with long-term infusions.…”

Section: Alternatives To IV Therapymentioning

confidence: 99%

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Peripheral Difficult Venous Access in Children

Rauch

Dowd

Eldridge

et al. 2009

Clin Pediatr (Phila)

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discuss management strategies. This article summarizes the recommendations of the consensus panel for physicians. The recommendations for nurses will be published separately. Definition and Scope of the ProblemEarly identification of DVA is the first step in optimizing patient care. The consensus panel described DVA as a clinical condition in which multiple attempts and/or special interventions are anticipated or required to achieve and maintain peripheral venous access. Special interventions are defined as the use of any technique or hospital resource with the potential to improve peripheral IV insertion success rates. These include traditional methods of enhancing the visibility and palpability of peripheral veins (eg, warming the catheter site to induce vasodilation) [10][11][12] ; advanced visualization technologies such as ultrasound, transillumination, and nearinfrared lighting 2,[13][14][15] ; and enlisting designated IV specialists and/or hospital staff with extensive experience in starting pediatric IVs.16 Some children may need more invasive interventions such as intraosseous (IO) infusion, a peripherally inserted central catheter, or a central venous catheter (CVC) to achieve parenteral access.There is a dearth of clinical evidence on the incidence of DVA in pediatric patients. Studies of IV insertion success rates indicate that 5% to 33% of children require more than 2 needle sticks to achieve IV access. [1][2][3][4] Even when interventions such as transillumination and ultrasound are used, up to 15% of children still require more than 2 attempts to establish venous access.2 A recent prospective analysis of 593 insertion attempts in centers with pediatric hospitalist services showed that successful placement E stablishing peripheral intravenous (IV) access in pediatric patients can be challenging. Clinical studies show that only 53% to 76% of children are successfully cannulated on the first attempt.1-4 Multiple failed attempts are painful and upsetting for the child and distressing for family members and caregivers, 5-9 yet there are no guidelines or consensus statements on the recognition and management of this problem.In January 2008, a panel of physicians and nurses specializing in emergency medicine, anesthesia, critical care, and hospital medicine convened to discuss peripheral difficult venous access (DVA) in children. Daniel Rauch, MD, FAAP, and Laura L. Kuensting, MSN(R), RN, CPNP, cochaired the roundtable discussion, which was made possible by a grant from Baxter Healthcare, Inc. The main objectives of the meeting were to estimate the frequency of DVA in pediatric patients; describe its clinical and emotional impact on the patient, the patient's family, and clinicians; develop terminology that accurately describes the condition; review the factors that help identify children with DVA; and

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“…Among these organizations are the American Heart Association (AHA), addressing vascular access in cardiac arrest patients, 1 the International Committee on Resuscitation, 2 the European Resuscitation Council, 3 the Infusion Nurses Society, 4 the National Association of EMS Physicians, 5 with the Emergency Nurses Association and the American Association of Critical-Care Nurses (AACN) endorsing the position paper of the Infusion Nurses Society. 6,7 These professional societies recognized that intraosseous access may provide significant time savings that could benefit patients in emergent situations by decreasing the time required to achieve access and the time required to administer necessary fluids and medications.…”

mentioning

confidence: 99%

Recommendations for the Use of Intraosseous Vascular Access for Emergent and Nonemergent Situations in Various Health Care Settings: A Consensus Paper

Phillips

Brown²,

Campbell³

et al. 2010

Critical Care Nurse

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The Role of Intraosseous Vascular Access in the Out-of-Hospital Environment (Resource Document to NAEMSP Position Statement)

Cited by 99 publications

References 21 publications

Intraosseous Versus Intravenous Infusion of Hydroxocobalamin for the Treatment Of Acute Severe Cyanide Toxicity in a Swine Model

Intraosseous Versus Intravenous Infusion of Hydroxocobalamin for the Treatment Of Acute Severe Cyanide Toxicity in a Swine Model

Peripheral Difficult Venous Access in Children

Recommendations for the Use of Intraosseous Vascular Access for Emergent and Nonemergent Situations in Various Health Care Settings: A Consensus Paper

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