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Correspondence| Volume 34, ISSUE 6, P1166-1167, June 01, 2016

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
Comparison of NIO and EZ-IO intraosseous access devices in adult patients under resuscitation performed by paramedics: a randomized crossover manikin trial
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      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.
      Ann Emerg Med. 2005; 46: 456-461
      ]. 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.
      Circulation. 2015; 132: S444-S464https://doi.org/10.1161/CIR.0000000000000261
      ]. 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.
      Am J Emerg Med. 2016; 34: 321-322https://doi.org/10.1016/j.ajem.2015.11.013
      ]. All drugs and intravenous solutions may be administered through IO access [
      • LaRocco B.G.
      • Wang H.E.
      Intraosseous infusion.
      Prehosp Emerg Care. 2003; 7: 280-285
      ]; 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.
      West J Emerg Med. 2013; 14: 440-443https://doi.org/10.5811/westjem.2013.1.12000
      ].
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      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
        View in Article
        • 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
        View in Article
        • 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
        View in Article
        • LaRocco B.G.
        • Wang H.E.
        Intraosseous infusion.
        Prehosp Emerg Care. 2003; 7: 280-285
        View in Article
        • 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
        View in Article

      Article Info

      Publication History

      Published online: March 08, 2016
      Accepted: March 5, 2016
      Received: February 15, 2016

      Footnotes

      ☆Conflict of interest statement: No conflict of interest to declare.

      Identification

      DOI: https://doi.org/10.1016/j.ajem.2016.03.017

      Copyright

      © 2016 Elsevier Inc. All rights reserved.

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