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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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References

1. Fowler, R, Gallagher, JV, Isaacs, SM, et al. The role of intraosseous vascular access in the out-of-hospital environment. Prehosp Emerg Care. 2007;11(1):63-66.CrossRefGoogle ScholarPubMed
2. Drinker, CK, Drinker, KR, Lund, CC. The circulation in the mammalian bone-marrow: with especial reference to the factors concerned in the movement of red blood-cells from the bone-marrow into the circulating blood as disclosed by perfusion of the tibia of the fog and by injections of the bone-marrow in the rabbit and cat. Am J Physiol. 1922;62(1):1-92.CrossRefGoogle Scholar
3. Engle, WA. Intraosseous access for administration of medications in neonates. Clin Perinatol. 2006;33(1):161-168.CrossRefGoogle ScholarPubMed
4. Tibballs, J. Australian Resuscitation Council: Paediatric advanced life support (PALS) guidelines 2006. Crit Care Resusc. 2006;8(2):132-134.Google Scholar
5. Gazin, N, Auger, H, Jabre, P, 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.Google Scholar
6. Byars, D, Tsuchitani, SN, Erwin, E, et al. Evaluation of success rate and access time for an adult sternal intraosseous device deployed in the prehospital setting. Prehosp Disaster Med. 2011;26(2):127-129.Google Scholar
7. Findlay, J, Johnson, DL, Macnab, AJ, et al. Paramedic evaluation of adult intraosseous infusion system. Prehosp Disaster Med. 2006;21(5):329-334.Google Scholar
8. Smith, E, McDonald, S, Wasiak, J, Jennings, P, MacPherson, C, Archer, F. The development of a prehospital search filter for the Cochrane Library. Journal of Emergency Primary Health Care. 2004;2(1-2). http://www.jephc.com/full_article.cfm?content_id=152. Accessed July 19, 2012.Google Scholar
9. Frascone, RJ, Jensen, J, Wewerka, SS, Salzman, JG. Use of the pediatric EZ-IO needle by emergency medical services providers. Pediatr Emerg Care. 2009;25(5):329-332.CrossRefGoogle ScholarPubMed
10. Horton, MA, Beamer, C, Horton, MA, Beamer, C. Powered intraosseous insertion provides safe and effective vascular access for pediatric emergency patients. Pediatr Emerg Care. 2008;24(6):347-350.CrossRefGoogle ScholarPubMed
11. Levitan, RM, Bortle, CD, Snyder, TA, et al. 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.CrossRefGoogle ScholarPubMed
12. Macnab, A, Christenson, J, Findlay, J, et al. A new system for sternal intraosseous infusion in adults. Prehosp Emerg Care. 2000;4(2):173-177.CrossRefGoogle ScholarPubMed
13. Miller, DD, Guimond, G, Hostler, DP, et al. Feasibility of sternal intraosseous access by emergency medical technician students. Prehosp Emerg Care. 2005;9(1):73-78.Google Scholar
14. Gerritse, BM, Scheffer, GJ, Draaisma, JM. Prehospital intraosseous access with the bone injection gun by a helicopter-transported emergency medical team. J Trauma. 2009;66(6):1739-1741.Google Scholar
15. Schwartz, D, Amir, L, Dichter, R, et al. The use of a powered device for intraosseous drug and fluid administration in a national EMS: A 4-year experience. J Trauma. 2008;64(3):650-654. Discussion, pp 4-5.Google Scholar
16. Hubble, MW, Trigg, DC. Training prehospital personnel in saphenous vein cutdown and adult intraosseous access techniques. Prehosp Emerg Care. 2001;5(2):181-189.CrossRefGoogle ScholarPubMed
17. Anderson, TE, Arthur, K, Kleinman, M, et al. Intraosseous infusion: Success of a standardized regional training program for prehospital advanced life support providers. Ann Emerg Med. 1994;23(1):52-55.Google Scholar
18. Fiorito, BA, Mizra, F, Doran, TM, et al. Intraosseous access in the setting of pediatric critical care transport. Pediatr Crit Care Med. 2005;6(1):50-53.Google Scholar
19. Glaeser, PW, Hellmich, TR, Szewczuga, D, et al. Five-year experience in prehospital intraosseous infusions in children and adults. Ann Emerg Med. 1993;22(7):1119-1124.CrossRefGoogle ScholarPubMed
20. Miner, WF, Corneli, HM, Bolte, RG, et al. Prehospital use of intraosseous infusion by paramedics. Pediatr Emerg Care. 1989;5(1):5-7.CrossRefGoogle ScholarPubMed
21. Pfister, C, Egger, L, Wirthmüller, B, Greif, R. Structured training in intraosseous infusion to improve potentially life-saving skills in pediatric emergencies - Results of an open prospective national quality development project over 3 years. Pediatr Anesth. 2008;18(3):223-229.CrossRefGoogle ScholarPubMed
22. Seigler, RS. Intraosseous infusion performed in the prehospital setting: South Carolina′s six-year experience. J S C Med Assoc. 1997;93(6):209-215.Google ScholarPubMed
23. Seigler, RS, Tecklenburg, FW, Shealy, R. Prehospital intraosseous infusion by emergency medical services personnel: a prospective study. Pediatrics. 1989;84(1):173-177.Google Scholar
24. Smith, RJ, Keseg, DP, Manley, LK, Standeford, T. Intraosseous infusions by prehospital personnel in critically ill pediatric patients. Ann Emerg Med. 1988;17(5):491-495.Google Scholar
25. Hartholt, KA, van Lieshout, EM, Thies, WC, et al. Intraosseous devices: a randomized controlled trial comparing three intraosseous devices. Prehosp Emerg Care. 2010;14(1):6-13.Google Scholar
26. Frascone, RJ, Jensen, JP, Kaye, K, Salzman, JG. Consecutive field trials using two different intraosseous devices. Prehosp Emerg Care. 2007;11(2):164-171.Google Scholar
27. Brenner, T, Bernhard, M, Helm, M, et al. Comparison of two intraosseous infusion systems for adult emergency medical use. Resuscitation. 2008;78(3):314-319.Google Scholar
28. Halvorsen, L, Bay, BK, Perron, PR, et al. Evaluation of an intraosseous infusion device for the resuscitation of hypovolemic shock. J Trauma. 1990;30(6):652-659.Google Scholar
29. Runyon, DE, Bruttig, SP, Dubick, MA, et al. Resuscitation from hypovolemia in swine with intraosseous infusion of a saturated salt-dextran solution. J Trauma. 1994;36(1):11-19.CrossRefGoogle ScholarPubMed
30. Halm, B, Yamamoto, LG. Comparing ease of intraosseous needle placement: Jamshidi versus Cook. Am J Emerg Med. 1998;16(4):420-421.Google Scholar
31. Fuchs, S, LaCovey, D, Paris, P. A prehospital model of intraosseous infusion. Ann Emerg Med. 1991;20(4):371-374.CrossRefGoogle ScholarPubMed
32. Shavit, I, Hoffmann, Y, Galbraith, R, Waisman, Y. Comparison of two mechanical intraosseous infusion devices: a pilot, randomized crossover trial. Resuscitation. 2009;80(9):1029-1033.CrossRefGoogle ScholarPubMed