Elsevier

Resuscitation

Volume 84, Issue 4, April 2013, Pages 440-445
Resuscitation

Clinical paper
EZ-IO® intraosseous device implementation in a pre-hospital emergency service: A prospective study and review of the literature?

https://doi.org/10.1016/j.resuscitation.2012.11.006Get rights and content

Abstract

Introduction

Intraosseous access is increasingly recognised as an effective alternative vascular access to peripheral venous access. We aimed to prospectively study the patients receiving prehospital intraosseous access with the EZ-IO®, and to compare our results with those of the available literature.

Methods

Every patient who required an intraosseous access with the EZ-IO from January 1st, 2009 to December 31st, 2011 was included. The main data collected were: age, sex, indication for intraosseous access, localisation of insertion, success rate, drugs and fluids administered, and complications. All published studies concerning the EZ-IO device were systematically searched and reviewed for comparison.

Results

Fifty-eight patients representing 60 EZ-IO procedures were included. Mean age was 47 years (range 0.5–91), and the success rate was 90%. The main indications were cardiorespiratory arrest (74%), major trauma (12%), and shock (5%). The anterior tibia was the main route. The main drugs administered were adrenaline (epinephrine), atropine and amiodarone. No complications were reported. We identified 30 heterogeneous studies representing 1603 EZ-IO insertions. The patients’ characteristics and success rate were similar to our study. Complications were reported in 13 cases (1.3%).

Conclusion

The EZ-IO provides an effective way to achieve vascular access in the pre-hospital setting. Our results were similar to the cumulative results of all studies involving the use of the EZ-IO, and that can be used for comparison for further studies.

Introduction

Rapid intravascular access is frequently required in order to administer emergency drugs or fluids in critical patients. Peripheral venous cannulation remains the standard of care, but may be altogether difficult to achieve and time-consuming in life-threatening situations. Intraosseous (IO) access is increasingly recognised as an effective alternative to peripheral venous cannulation. The IO access is characterised by a rapid learning curve and an effectiveness equivalent to peripheral venous cannulation in terms of pharmacokinetic and clinical efficacy.1, 2 Initially used in children, IO access has been implemented progressively with good results in the adult population, particularly since the development of the semi-automatic insertion devices in the late 90s, which may be more effective than manual IO techniques.3 Since 2010, IO access became a standard of care in adult advanced life support and the first recommended alternative to peripheral venous cannulation in cardiac arrest patients.4 Contraindications include orthopaedic hardware, infection at the site of insertion, traumatic extensive limb injuries, amputation of a limb and osseous pathologies such as osteogenesis imperfecta.5

The EZ-IO®, a new power drill semi-automatic device, has been introduced over the last ten years. To date, several articles about the EZ-IO device use have been published. They are mainly focused on the success rate and rapidity of insertion, but there is limited information about the complications and outcomes of patients in whom an intraosseous access has been attempted.

We prospectively studied the indications, localisations, medications administered and success rate of achieving intraosseous access with the EZ-IO in a physician-based pre-hospital setting. The complications and mortality rate of patients were also recorded. At the same time, all the published studies involving the EZ-IO device in the emergency setting were systematically reviewed in order to compare the results of our study, and to inventory all drugs and fluids administered by this route.

Section snippets

Study design and setting

This prospective study was conducted from January 1st, 2009 to December 31st, 2011, in the pre-hospital emergency medical service (EMS) of the Centre Hospitalier Universitaire Vaudois (CHUV). The CHUV is a 1000-bed university hospital located in Lausanne, Switzerland, and is the level 1 Trauma Centre and Burn Centre for a population of over one million people in the western part of the country. It is also the primary hospital for an immediate catchment area comprising about 300 000 persons. Road

Results

Among the 8378 patients who required an emergency physician intervention during the study period, 58 patients (0.7%) met the inclusion criteria, representing 60 EZ-IO insertion attempts (two patients each underwent two intraosseous insertion attempts).

Discussion

The predominance of males among our study subjects is consistent with the findings of other studies, and is most likely explained by the large proportion of cardio-respiratory arrests and major trauma situations. The 90% success rate of EZ-IO insertion in our study is similar to the pooled data of the available studies (Table 2).6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35 The failure to achieve IO access in our study was

Conclusion

The EZ-IO device was shown to be effective in achieving vascular access in the pre-hospital setting. The 90% success rate, the localisation of insertion and the reasons for inserting an intraosseous device were similar to what is described in the literature. The intraosseous route can be used to administer a wide range of drugs and fluids.

Further studies are needed to evaluate the impact of the intraosseous route, particularly on the patient's survival, and on the occurrence of delayed

Conflict of interest statement

None to declare. The EZ-IO devices were the property of the Emergency Service and the study was conducted independently of the manufacturer.

Source of funding

Funding was provided exclusively by the Emergency Service, Lausanne University Hospital, Lausanne, Switzerland.

Acknowledgement

We would like to thank Danielle Wyss for proofreading and final translation.

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    A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2012.11.006.

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