The Usefulness of Humeral Intraosseous Infusion Performed by Rapid Response Vehicle Staff in Patients with Cardiac Arrest: A Single-Centre, Retrospective Study

Abstract

Background Humeral intraosseous infusion (IOI) is often performed in the prehospital setting by rapid response vehicle staff. IOI is used to administer extracellular fluid products and resuscitation drugs such as adrenaline to patients with trauma and cardiac arrest when venous channels are difficult to secure. However, in Japan, its usefulness is not well recognised, and it is rarely performed aggressively. This study aimed to demonstrate that humeral IOI is superior to the conventional peripheral venous infusion (VI) in cardiac arrest.Methods Among cases that received emergency care by rapid response vehicle staff from 2017 to 2022, 363 patients with cardiac arrest were transported to our institution with well-defined timing information. Patients were divided into humeral IOI and peripheral VI groups and compared in terms of age, sex, time from dispatch to contact and arrival at the hospital, time spent at the scene, distance travelled, type of injury, and return of spontaneous circulation (ROSC). Incident reports related to IOI during this period were also investigated. Continuous variables were compared by analyses of variance. Categorical data were compared using the chi-square test.Results There were no significant differences in terms of age, sex, time (min) from onset to dispatch (IOI: 3.19 ± 0.88, VI: 3.85 ± 0.60, P = 0.54), contact (IOI: 13.53 ± 0.96, VI: 14.11 ± 0.66, P = 0.62), and hospital arrival (IOI: 30.37 ± 1.15, VI: 30.51 ± 0.79, P = 0.92), time spent at the scene (IOI: 8.96 ± 0.35, VI: 8.25 ± 0.24, P = 0.1), or mileage (km) (IOI: 9.23 ± 0.46, VI: 9.58 ± 0.32, P = 0.53). There were significantly more cases of ROSC in the IOI group than in the VI group (IOI: yes 47: no 70, VI: yes 41: no 95, P = 0.001). There were no incident reports, such as unnoticed complications, continued infusions, and needle stick injury.Conclusions Humeral IOI required the same amount of time to perform as conventional peripheral VI but showed better outcomes in terms of ROSC. Humeral IOI is a valid infusion route until the completion of primary care. This simple and reliable procedure should be feasible for future prehospital emergency care.