Emergency intraosseous access in a helicopter emergency medical service: a retrospective study

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Oct 2010

Background Intraosseous access (IO) is a method for providing vascular access in out-of-hospital resuscitation of critically ill and injured patients when traditional intravenous access is difficult or impossible. Different intraosseous techniques have been used by our Helicopter Emergency Medical Services (HEMS) since 2003. Few articles document IO use by HEMS physicians. The aim of this study was to evaluate the use of intraosseous access in pre-hospital emergency situations handled by our HEMS. Methods We reviewed all medical records from the period May 2003 to April 2010, and compared three different techniques: Bone Injection Gun (B.I.G® - Waismed), manual bone marrow aspiration needle (Inter V - Medical Device Technologies) and EZ-IO® (Vidacare), used on both adults and paediatric patients. Results During this seven-year period, 78 insertion attempts were made on 70 patients. Overall success rates were 50% using the manual needle, 55% using the Bone Injection Gun, and 96% using the EZ-IO®. Rates of success on first attempt were significantly higher using the EZ-IO® compared to the manual needle/Bone Injection Gun (p < 0.01/p < 0.001). Fifteen failures were due to insertion-related problems (19.2%), with four technical problems (5.1%) and three extravasations (3.8%) being the most frequent causes. Intraosseous access was primarily used in connection with 53 patients in cardiac arrest (75.7%), including traumatic arrest, drowning and SIDS. Other diagnoses were seven patients with multi-trauma (10.0%), five with seizures/epilepsy (7.1%), three with respiratory failure (4.3%) and two others (2.9%). Nearly one third of all insertions (n = 22) were made in patients younger than two years. No cases of osteomyelitis or other serious complications were documented on the follow-up. Conclusions Newer intraosseous techniques may enable faster and more reliable vascular access, and this can lower the threshold for intraosseous access on both adult and paediatric patients in critical situations. We believe that all emergency services that handle critically ill or injured paediatric and adult patients should be familiar with intraosseous techniques.

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Emergency intraosseous access in a helicopter emergency medical service: a retrospective study

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Emergency intraosseous access in a helicopter emergency medical service: a retrospective study Geir A Sunde 0 2 Brd E Heradstveit 0 2 Bjarne H Vikenes 0 2 Jon K Heltne 0 1 2 0 Department of Anaesthesia and Intensive Care, Haukeland University Hospital , Bergen , Norway 1 Department of Medical Sciences, University of Bergen , Bergen , Norway 2 Helicopter Emergency Medical Services (HEMS) - Bergen , Norway Background: Intraosseous access (IO) is a method for providing vascular access in out-of-hospital resuscitation of critically ill and injured patients when traditional intravenous access is difficult or impossible. Different intraosseous techniques have been used by our Helicopter Emergency Medical Services (HEMS) since 2003. Few articles document IO use by HEMS physicians. The aim of this study was to evaluate the use of intraosseous access in prehospital emergency situations handled by our HEMS. Methods: We reviewed all medical records from the period May 2003 to April 2010, and compared three different techniques: Bone Injection Gun (B.I.G - Waismed), manual bone marrow aspiration needle (Inter V - Medical Device Technologies) and EZ-IO (Vidacare), used on both adults and paediatric patients. Results: During this seven-year period, 78 insertion attempts were made on 70 patients. Overall success rates were 50% using the manual needle, 55% using the Bone Injection Gun, and 96% using the EZ-IO. Rates of success on first attempt were significantly higher using the EZ-IO compared to the manual needle/Bone Injection Gun (p < 0.01/p < 0.001). Fifteen failures were due to insertion-related problems (19.2%), with four technical problems (5.1%) and three extravasations (3.8%) being the most frequent causes. Intraosseous access was primarily used in connection with 53 patients in cardiac arrest (75.7%), including traumatic arrest, drowning and SIDS. Other diagnoses were seven patients with multi-trauma (10.0%), five with seizures/epilepsy (7.1%), three with respiratory failure (4.3%) and two others (2.9%). Nearly one third of all insertions (n = 22) were made in patients younger than two years. No cases of osteomyelitis or other serious complications were documented on the follow-up. Conclusions: Newer intraosseous techniques may enable faster and more reliable vascular access, and this can lower the threshold for intraosseous access on both adult and paediatric patients in critical situations. We believe that all emergency services that handle critically ill or injured paediatric and adult patients should be familiar with intraosseous techniques. - Background Vascular access is important in the resuscitation of critically ill or injured adult and paediatric patients [1,2]. It can be challenging to obtain vascular access, especially in the resuscitation of small children in emergency situations [3-5]. The European Resuscitation Council 2005 guidelines [6] and International Liaison Committee on Resuscitation guidelines [4] recommend intraosseous access during resuscitation if intravenous access proves to be difficult or impossible. Despite these recommendations, intraosseous techniques appear to be rarely used [7]. While numerous reports have been published about the use of different intraosseous devices in emergency patients, they are primarily from paramedic-based ambulance services [2,8]. Few comparisons have been published of different IO techniques used by physicians in emergency departments [7] or in HEMS services manned by physicians/nurses [9,10]. Typical HEMS operating conditions make special demands on medical equipment such as IO devices. Rain, cold, darkness and non-sterile conditions mean that such equipment must be durable and simple to use in all conditions. User friendliness is important for rescuers, both on-scene and in-flight [10]. Intravenous access is traditionally regarded as the optimal route for medication and fluids, and the intraosseous route is often described as the best alternative choice [3,4,11]. Endotracheal, umbilical or intracardial routes are poorer alternatives as regards speed of insertion and reliability in emergency resuscitation. Great saphenous vein cutdown as an emergency surgical approach has also been replaced by the faster IO technique [3,12]. In newborn resuscitation, umbilical venous access is often preferred, with intraosseous as an alternative route [12,13]. Intraosseous technique has been described as a simple and reliable method in both cadaver and clinical studies [9,11,14]. The aim of this study was to evaluate the use of intraosseous access in emergency situations handled by physicians in a pre-hospital HEMS service. Methods Our HEMS helicopter and rapid response vehicle are based at the regional university hospital. The HEMS covers an area of about 15,500 square kilometres of Western Norway, with a population of approximately 500,000. The majority (97%) of missions are code red emerge (...truncated)


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Geir A Sunde, Bård E Heradstveit, Bjarne H Vikenes, Jon K Heltne. Emergency intraosseous access in a helicopter emergency medical service: a retrospective study, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2010, pp. 52, 18, DOI: 10.1186/1757-7241-18-52