Abstract
Objective
In emergency medicine, the intraosseous access (IOA) is the alternative to the intravenous access. Our aim was to evaluate the use of a semiautomatic IOA device (EZ-IO®) in ground and air based physician staffed emergency medical systems and at a university hospital.
Methods
Since January 2008, the EZ-IO® system was evaluated prospectively for four years and analysed statistically.
Results
83 IOA were performed in prehospital and 5 in in-hospital setting. 78% of the patients were adults; 22% were children between 7 days and 6 years. 98% of all patients were in potentially life-threatening situations (NACA IV–VII). IOA was established during CPR in 55%. The primary insertion site was the proximal tibia (98%). In children, IOA was used significantly more often as primary access to the vascular system than in adults (86.2% vs. 38.9%, p <0.001). First attempt/overall success rates were 94% / 99%. Unsuccessful attempts occurred in 7.8% (n=7). In the prehospital ground based physician staffed EMS, IOA was established in 69 of 20.175 missions (0.34%).
Conclusions
The semiautomatic EZ-IO® system is an effective method for achieving vascular access. In critically ill children, it was used more often as first approach to the vascular system compared with adults.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Leidel BA, Kirchhoff C, Braunstein V, Bogner V, Biberthaler P, Kanz KG. Comparison of two intraosseous access devices in adult patients under resuscitation in the emergency department: A prospective, randomized study. Resuscitation. 2010;81(8):994–999
Sunde GA, Heradstveit BE, Vikenes BH, Heltne JK. Emergency intraosseous access in a helicopter emergency medical service: a retrospective study. Scand J Trauma Resusc Emerg Med. 2010;18:52.
Levitan RM, Bortle CD, Snyder TA, Nitsch DA, Pisaturo JT, Butler KH. Use of a battery-operated needle driver for intraosseous access by novice users: skill acquisition with cadavers. Ann Emerg Med. 2009;54(5):692–694
Frascone RJ, Jensen JP, Kaye K, Salzman JG. Consecutive field trials using two different intraosseous devices. Prehosp Emerg Care. 2007;11(2):164–171
Brenner T, Bernhard M, Helm M, Doll S, Volkl A, Ganion N, et al. Comparison of two intraosseous infusion systems for adult emergency medical use. Resuscitation. 2008;78(3):314–319
Deakin CD, Morrison LJ, Morley PT, Callaway CW, Kerber RE, Kronick SL, et al. Part 8: Advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation. 2010; 81Suppl 1: e93–e174
Gazin N, Auger H, Jabre P, Jaulin C, Lecarpentier E, Bertrand C, et al. Efficacy and safety of the EZ-IO intraosseous device: Out-of-hospital implementation of a management algorithm for difficult vascular access. Resuscitation. 2011;82(1):126–129
Helm M, Hossfeld B, Schlechtriemen T, Braun J, Lampl L, Bernhard M. [Use of intraosseus infusion in the German air rescue service: nationwide analysis in the time period 2005 to 2009]. Anaesthesist. 2011;60(12):1119–1125
Kellner P, Eggers M, Rachut B. Der Einsatz des intraossären Zugangs im präklinischen Notarztdienst. Notfall Rettungsmed. 2011;14:379–388
Helm M, Biehn G, Lampl L, Bernhard M. [Pediatric emergency patients in the air rescue service. Mission reality with special consideration to “invasive” measures]. Anaesthesist. 2010;59(10): 896–903
Schalk R, Schweigkofler U, Lotz G, Zacharowski K, Latasch L, Byhahn C. Efficacy of the EZ-IO needle driver for out-of-hospital intraosseous access—a preliminary, observational, multicenter study. Scand J Trauma Resusc Emerg Med. 2011;19:65
Myers LA, Russi CS, Arteaga GM. Semiautomatic intraosseous devices in pediatric prehospital care. Prehosp Emerg Care. 2011;15(4):473–476
Leidel BA, Kirchhoff C, Bogner V, Braunstein V, Biberthaler P, Kanz KG. Comparison of intraosseous versus central venous vascular access in adults under resuscitation in the emergency department with inaccessible peripheral veins. Resuscitation. 2012;83(1):40–45
Bernhard M, Gräsner J, Gries A, Fischer M, Böttiger BW, Helm M. Die intraossäre Infusion in der Notfallmedizin. Anästh Intensivmed. 2010;51: S615–S620
Reades R, Studnek JR, Vandeventer S, Garrett J. Intraosseous versus intravenous vascular access during out-of-hospital cardiac arrest: a randomized controlled trial. Ann Emerg Med. 2011;58(6):509–516
Moen TC, Sarwark JF. Compartment syndrome following intraosseous infusion. Orthopedics. 2008;31(8):815
Simmons CM, Johnson NE, Perkin RM, van Stralen D. Intraosseous extravasation complication reports. Ann Emerg Med. 1994;23(2):363–366
Bowley DM, Loveland J, Pitcher GJ. Tibial fracture as a complication of intraosseous infusion during pediatric resuscitation. J Trauma. 2003;55(4):786–787
Melker RJ, Miller G, Gearen P, Molliter L. Complications of intraosseous infusion. Ann Emerg Med. 1990;19(6):731–732
van Rijn RR, Knoester H, Maes A, van der Wal AC, Kubat B. Cerebral arterial air embolism in a child after intraosseous infusion. Emerg Radiol. 2008;15(4): 259–6252
Rosetti VA, Thompson BM, Miller J, Mateer JR, Aprahamian C. Intraosseous infusion: an alternative route of pediatric intravascular access. Ann Emerg Med. 1985;14(9):885–888
Author information
Authors and Affiliations
Corresponding author
Additional information
Dr. Reinhardt and Dr. Brenner contributed equally as first author of this work and in preparing the original research paper.
About this article
Cite this article
Reinhardt, L., Brenner, T., Bernhard, M. et al. Four years of EZ-IO® system in the preand in-hospital emergency setting. cent.eur.j.med 8, 166–171 (2013). https://doi.org/10.2478/s11536-012-0125-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.2478/s11536-012-0125-6