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Intraosseous Access in the Prehospital Setting: Literature Review

Published online by Cambridge University Press:  09 August 2012

Alexander Olaussen  and
Brett Williams
Alexander Olaussen
Affiliation:
School of Primary Health Care, Monash University–Peninsula Campus, Frankston, Victoria, Australia
Brett Williams*
Affiliation:
School of Primary Health Care, Monash University–Peninsula Campus, Frankston, Victoria, Australia
*
Correspondence: Brett Williams, PhD, FPA Department of Community Emergency Health and Paramedic Practice Faculty of Medicine, Nursing and Health Sciences Monash University–Peninsula Campus McMahons Road Frankston, Victoria, 3199 Australia E-mail brett.williams@med.monash.edu.au
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Abstract

Background

Although the majority of Australian intensive care paramedics use the manual intraosseous infusion technique (MAN-IO), several other semiautomatic devices now are available, such as the bone injection gun (BIG) and the semiautomatic intraosseous infusion system (EZ-IO). Given the choice of devices now available, questions have been raised regarding success rates, accuracy, decay of skills, and adverse events.

Objectives

Review the literature regarding the use of intraosseous (IO) devices in the prehospital setting.

Methods

Selected electronic databases (Medline, Embase, and CINAHL) were searched, and a hand search was conducted for grey-literature that included studies from the commencement of the process to the end of May 2010. Inclusion criteria were any study reporting intraosseous insertion and/or infusion (adult and pediatric) by paramedics in the prehospital setting.

Findings

The search located 2,100 articles; 20 articles met the inclusion criteria. The review also noted that use of IO access (regardless of technique) offers a safe and simple method for gaining access to the patients’ vascular system. A number of studies found that the use of semiautomatic devices offers better and faster intraosseous access compared with the use of manual devices, and also were associated with fewer complications. The findings also suggest that the use of semiautomatic devices can reduce insertion times and the number of insertion attempts when contrasted with the use of manual insertion techniques. Despite these findings, statistically no specific IO device has proven clinical superiority.

Conclusion

While manual IO techniques currently are used by the majority of Australian paramedics, the currently available evidence suggests that semiautomatic devices are more effective. Further research, including cost-benefit analyses, is required at a national level to examine skill acquisition, adverse effects, and whether comparative devices offer clinically significant advantages.

OlaussenA, WilliamsB. Intraosseous Access in the Prehospital Setting: Literature Review. Prehosp Disaster Med.2012;27(5):1-5.

Keywords

complicationsinsertion timeintraosseousparamedicsprehospitalsuccess rate
Type
Comprehensive Review
Information
Prehospital and Disaster Medicine , Volume 27 , Issue 5 , October 2012 , pp. 468 - 472
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2012

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