Comparison of Two Intraosseous Access Devices Employed During Simulated Cardiopulmonary Resuscitation. A Prospective, Randomized, Crossover, Manikin Study

Abstract

BACKGROUND: Intraosseous injection is an alternative method used regarding unsuccessful intravenous access during many emergency situations. The aim of the present study was to compare injections made by the Bone Injection Gun (BIG) with NIO Adult intraosseous access devices during simulated CPR performed by paramedics. METHODS: 40 paramedics took part in this prospective, randomized, crossover, manikin study. The participants were chosen at random, while each paramedic performed an intraosseous injection with the Bone Injection Gun (BIG) or with the NIO Adult Intraosseous access device. The effectiveness of the intraosseous injection was analyzed as times T1, T2, and T3. Time T1 is defined as the time-lapse from placing the intraosseous device into one's hand to performing the intraosseous injection; Time T2 is the time-lapse from placing the intraosseous device into one's hand to the moment of stabilizing it at the injection site; while Time T3 is defined as the time-lapse from putting the intraosseous device into one's hand, attaching the syringe with a test aspiration, to connecting the infusion line. Attitudes toward the use of intraosseous access during resuscitation were also analyzed in the present study. RESULTS: The efficacy of intraosseous access obtained with the use of NIO was at 100% where the efficacy of the use of BIG was at 95%. The average time of T1 was similar in the groups randomized to use BIG and NIO, represented as 5.4 ± 3.5 vs. 3.5 ± 2.5 s, respectively (p = 0.014); the average time of T2 was 17.5 ± 4.5 vs. 3.5 ± 2.5 s, respectively (p < 0.001); while the average time of T3 was 25 ± 5.5 vs. 11.5 ± 2.5 s, respectively (p < 0.001). Notably, 90% of the study's participating paramedics preferred to use the NIO during cardiopulmonary resuscitation (p < 0.001). CONCLUSIONS: The present study shows that after a short period of training paramedics can perform an intraosseous injection with a high degree of efficiency. Thus, the authors stress the need for training medical personnel to have the skill to perform intraosseous injections along with knowledge and understanding of the indications and contraindication for IO access.