Use of intraosseous devices in trauma: a survey of trauma practitioners in Canada, Australia and New Zealand

Abstract

Background: Although used primarily in the pediatric population for decades, the use of intraosseous (IO) devices in the resuscitation of severely injured adult trauma patients has recently become more commonplace. The objective of this study was to determine the experience level, beliefs and attitudes of trauma practitioners in Canada, Australia and New Zealand regarding the use of IO devices in adult trauma patients. Methods:We administered a web-based survey to all members of 4 national trauma and emergency medicine organizations in Canada, Australia and New Zealand. Survey responses were analyzed using descriptive statistics, univariate comparisons and a proportional odds model. Results:Overall, 425 of 1771 members completed the survey, with 375 being trauma practitioners. IO devices were available to 97% (353 of 363), with EZ-IO being the most common. Nearly all physicians (98%, 357 of 366) had previous training with IO devices, and 85% (223 of 261) had previously used an IO device in adult trauma patients. Most respondents (79%, 285 of 361) were very comfortable placing an IO catheter in the proximal tibia. Most physicians would always or often use an IO catheter in a patient without intravenous access undergoing CPR for traumatic cardiac arrest (84%, 274 of 326) or in a hypotensive patient (without peripheral intravenous access) after 2 attempts or 90 s of trying to establish vascular access (81%, 264 of 326). Conclusion:Intraosseous devices are readily available to trauma practitioners in Canada, Australia and New Zealand, and most physicians are trained in device placement. Most physicians surveyed felt comfortable using an IO device in resuscitation of adult trauma patients and would do so for indications broader than current guidelines. Contexte :Bien que le dispositif de perfusion intraosseuse soit depuis des décennies utilisé principalement chez les enfants, son utilisation lors de la réanimation d'adultes victimes de trauma grièvement blessés a récemment gagné en popularité. Notre étude vise à déterminer le niveau d'expérience, les croyances et les attitudes des spécialistes en traumatologie canadiens, australiens et néo-zélandais en ce qui concerne l'utilisation de ces dispositifs chez des patients adultes victimes de trauma. Méthodes

The intraosseous have it: A prospective observational study of vascular access success rates in patients in extremis using video review

“…Despite its development in the early 1920s(4) and subsequent use in World War II, until recently intraosseous (IO) access was uncommonly utilized for vascular access in civilian populations of adult patients. (5). Of late, IO access has gained newfound popularity in part spurred by the American Heart Association (AHA) guidelines that call for prompt administration of resuscitation agents and minimal interruption of chest compressions for patients in cardiac arrest(6).…”

“…Of late, IO access has gained newfound popularity in part spurred by the American Heart Association (AHA) guidelines that call for prompt administration of resuscitation agents and minimal interruption of chest compressions for patients in cardiac arrest(6). In the trauma population, the modern military combat experience has led to increased attention to IO access in both clinical practice and scientific investigation (7) (5).…”

Prehospital transfusion of low titer cold‐stored whole blood through the intraosseous route in a trauma patient with hemorrhagic shock

“…The IO access was performed in the proximal humerus which offers a readily available location for IO catheter placement with rapid access to the central circulation. Its placement is significantly faster than peripheral venous access, and the flow rates are approximately 1.8 times faster than those in the proximal tibia . During the 22 minutes helicopter flight, the patient was treated with manual syringe injection of two units (1000 mL) of whole blood.…”

“…Its placement is significantly faster than peripheral venous access, and the flow rates are approximately 1.8 times faster than those in the proximal tibia. [16][17][18] During the 22 minutes helicopter flight, the patient was treated with manual syringe injection of two units (1000 mL) of whole blood. This means that the mean infusion rate was approximately 45 mL/min, a flow rate that seems to be sufficient to maintain the rate needed to fulfill criteria for massive transfusion.…”

Anesthesia and Analgesia In War and Terror Injuries

“…Ultrason rehberliğinde damar yolu açılması damar yolu açılamayan ya da santral damar yolu açılması gerekli durumlarda kurtarıcı ve daha güvenli olabilmektedir (15,16) . Damar yolu açılamayan hastalarada interosseoz damar yolu açma cihazları da kullanılarak interosseöz yol denenmelidir (17,18) . Açılacak damar yolu olabildiğince travmaya uğramış vücut bölgesinin uzağında olmalı, damar ve doku bütünlüğünün bozulmadığı düşünülen bölgelerden denenmelidir.…”