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Emergency Burr Hole utilizing the EZ-IO™ drill: A pilot cadaver study

  • Mark L. Gustafson
    Correspondence
    Corresponding author at: 3110 MacCorkle Avenue S.E., Charleston, WV 25304, USA
    Affiliations
    Department of Emergency Medicine, Charleston Area Medical Center, Graduate Medical Education, 3110 MacCorkle Avenue S.E., Charleston, WV 25304, USA

    Charleston Area Medical Center, Life Support Training and Simulation Center, 501 Morris Street, General Hospital - 5 East, Charleston, WV 25301, USA
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  • Jerry Edwards
    Affiliations
    Department of Emergency Medicine, Charleston Area Medical Center, Graduate Medical Education, 3110 MacCorkle Avenue S.E., Charleston, WV 25304, USA
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  • Alfred Tager
    Affiliations
    Charleston Area Medical Center Health Education and Research Institute, 3200 MacCorkle Ave. SE, Charleston, WV 25304, USA
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      Delayed surgical care increases mortality and worsens neurologic outcomes in patients with an Epidural Hematoma (EDH) that are deteriorating and showing signs of herniation or coma [
      • Cohen J.E.
      • Montero A.
      • Israel Z.H.
      Prognosis and clinical relevance of anisocoria-craniotomy latency for epidural hematoma in comatose patients.
      ,
      • Ortler M.
      • Langmayr J.J.
      • Stockinger A.
      • et al.
      Prognosis of epidural hematoma: is emergency burr hole trephination in craniocerebral trauma still justified today?.
      ,
      • Haselsberger K.
      • Pucher R.
      • Auer L.M.
      Prognosis after acute subdural or epidural haemorrhage.
      ,
      • Poon W.S.
      • Li A.K.C.
      Comparison of management outcome of primary and secondary referred patients with traumatic extradural haematoma in a neurosurgical unit.
      ]. This procedure and the equipment used are rarely encountered in the Emergency Department (ED) and may not be as familiar to the Emergency Medicine Physician as the EZ-IO™ (EZ-IO™, Teleflex) drill they commonly use to obtain intraosseous (IO) access. There now have been two case reports describing the use of the EZ-IO™ drill in lieu of the traditional Emergency Burr hole procedure in patients with an EDH who are rapidly deteriorating and emergency surgery is unavailable. Bulstrode et al. in 2017 published a case report of a patient with an EDH where a neurosurgeon utilized the EZ-IO™ drill to drain an occipital site EDH [
      • Bulstrode H.
      • Kabwama S.
      • Durnford A.
      • et al.
      Temporising extradural haematoma by craniostomy using an intraosseous needle.
      ]. Then in 2018, Durnford et al. described the second case using an EZ-IO™ drill to drain a rapidly expanding EDH, this time in a rural hospital by an Emergency Medicine Physician with neurosurgeon guidance over the telephone [
      • Durnford S.
      • Bulstrode H.
      • Durnford A.
      • et al.
      Temporising an extradural haematoma by intraosseous needle craniostomy in the District General Hospital by non-neurosurgical doctors - a case report.
      ]. Outside of these two case reports there is little evidence defining this novel procedure.

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      References

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