Advertisement

Comparison of NIO and EZ-IO intraosseous access devices in adult patients under resuscitation performed by paramedics: a randomized crossover manikin trial

Published:March 08, 2016DOI:https://doi.org/10.1016/j.ajem.2016.03.017
      Obtaining intravascular (IV) access is one of the key procedures during cardiopulmonary resuscitation (CPR), particularly during nondefibrillation rhythms, in which the rapid delivery of epinephrine is one of the main elements of the emergency treatment. The average time needed for peripheral IV catheterization is reported to be between 2.5 and 16 minutes in patients with difficult IV access [
      • Costantino T.G.
      • Parikh A.K.
      • Satz W.A.
      • Fojtik J.P.
      Ultrasonography-guided peripheral intravenous access versus traditional approaches in patients with difficult intravenous access.
      ]. The 2015 American Heart Association guidelines for CPR suggest that rescuers establish intraosseous (IO) access if an intravenous line is not easily obtainable [
      • Link M.S.
      • Berkow L.C.
      • Kudenchuk P.J.
      • Halperin H.R.
      • Hess E.P.
      • Moitra V.K.
      • et al.
      Part 7. Adult advanced cardiovascular life support: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care.
      ]. IO access is usually established in the proximal part of the tibia, near the tibial tuberosity, or in the distal part, near the medial ankle. IO access allows the patient to be treated immediately by facilitating the administration of fluids and medications [
      • Szarpak L.
      • Truszewski Z.
      • Fudalej M.
      • Krajewski P.
      The intraosseous access devices as a method of vascular access during cardiopulmonary resuscitation.
      ]. All drugs and intravenous solutions may be administered through IO access [
      • LaRocco B.G.
      • Wang H.E.
      Intraosseous infusion.
      ]; however, it should not last longer than 24 hours and should be discontinued as soon as peripheral or central IV access has been established. The most frequent complications include hematoma, inflammation, and bone fractures [
      • Hallas P.
      • Brabrand M.
      • Folkestad L.
      Complication with intraosseous access: scandinavian users' experience.
      ].
      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Costantino T.G.
        • Parikh A.K.
        • Satz W.A.
        • Fojtik J.P.
        Ultrasonography-guided peripheral intravenous access versus traditional approaches in patients with difficult intravenous access.
        Ann Emerg Med. 2005; 46: 456-461
        • Link M.S.
        • Berkow L.C.
        • Kudenchuk P.J.
        • Halperin H.R.
        • Hess E.P.
        • Moitra V.K.
        • et al.
        Part 7. Adult advanced cardiovascular life support: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care.
        Circulation. 2015; 132: S444-S464https://doi.org/10.1161/CIR.0000000000000261
        • Szarpak L.
        • Truszewski Z.
        • Fudalej M.
        • Krajewski P.
        The intraosseous access devices as a method of vascular access during cardiopulmonary resuscitation.
        Am J Emerg Med. 2016; 34: 321-322https://doi.org/10.1016/j.ajem.2015.11.013
        • LaRocco B.G.
        • Wang H.E.
        Intraosseous infusion.
        Prehosp Emerg Care. 2003; 7: 280-285
        • Hallas P.
        • Brabrand M.
        • Folkestad L.
        Complication with intraosseous access: scandinavian users' experience.
        West J Emerg Med. 2013; 14: 440-443https://doi.org/10.5811/westjem.2013.1.12000