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intraosseous vs intravenous access

Michael S Lallemand, Donald M Moe, John M McClellan, Michael Loughren, Shannon Marko, Matthew J Eckert, Matthew J Martin
BACKGROUND: The acute coagulopathy of trauma is often accompanied by hyperfibrinolysis. TXA can reverse this phenomenon, and, when given early, decreases mortality from bleeding. Establishing IV access can be difficult in trauma and IO access is often preferred for drug administration. Currently, there is no data on the efficacy of IO administered TXA. Our objectives were to compare serum concentrations of tranexamic acid (TXA) when given IV and intraosseous (IO) and to compare the efficacy of IO administered TXA to IV at reversing hyperfibrinolysis METHODS: Using a porcine hemorrhage and ischemia-reperfusion (IR) model, 18 swine underwent hemorrhagic shock followed by a tissue plasminogen activator (tPA) infusion to induce hyperfibrinolysis...
December 1, 2017: Journal of Trauma and Acute Care Surgery
Bryan A Feinstein, Benjamin A Stubbs, Tom Rea, Peter J Kudenchuk
AIMS: Although the intraosseous (IO) route is increasingly used for vascular access in out-of-hospital cardiac arrest (OHCA), little is known about its comparative effectiveness relative to intravenous (IV) access. We evaluated clinical outcomes following OHCA comparing drug administration via IO versus IV routes. METHODS: This retrospective cohort study evaluated Emergency Medical Services (EMS)-treated adults with atraumatic OHCA in a large metropolitan EMS system between 9/1/2012-12/31/2014...
August 2017: Resuscitation
Brian Clemency, Kaori Tanaka, Paul May, Johanna Innes, Sara Zagroba, Jacqueline Blaszak, David Hostler, Derek Cooney, Kevin McGee, Heather Lindstrom
INTRODUCTION: Guidelines endorse intravenous (IV) and intraosseous (IO) medication administration for cardiac arrest treatment. Limited clinical evidence supports this recommendation. A multiagency, retrospective study was performed to determine the association between parenteral access type and return of spontaneous circulation (ROSC) in out of hospital cardiac arrest. METHODS: This was a structured, retrospective chart review of emergency medical services (EMS) records from three agencies...
February 2017: American Journal of Emergency Medicine
Justin Fulkerson, Robert Lowe, Tristan Anderson, Heather Moore, William Craig, Don Johnson
INTRODUCTION: This study compared the effects of vasopressin via tibial intraosseous (IO) and intravenous (IV) routes on maximum plasma concentration (Cmax), the time to maximum concentration (Tmax), return of spontaneous circulation (ROSC), and time to ROSC in a hypovolemic cardiac arrest model. METHODS: This study was a randomized prospective, between-subjects experimental design. A computer program randomly assigned 28 Yorkshire swine to one of four groups: IV (n=7), IO tibia (n=7), cardiopulmonary resuscitation (CPR) + defibrillation (n=7), and a control group that received just CPR (n=7)...
March 2016: Western Journal of Emergency Medicine
Karin Reuter-Rice, Dana Patrick, Elizabeth Kantor, Cathy Nolin, Jennifer Foley
Intraosseous (IO) access is a standard of care for pediatric emergencies in the absence of conventional intravenous access. Intraosseous needles provide access for resuscitation fluids and medications and are often placed in the emergency department. However, there are no studies to date that describe the characteristics of pediatric IO needle recipients or their dispositions and outcomes. This study examined the characteristics and disposition of children following IO needle placement by prehospital and emergency room teams before being transported to a children's hospital...
October 2015: Advanced Emergency Nursing Journal
Jason Cohen, Luke Duncan, Wayne Triner, Jeffrey Rea, Gary Siskin, Christopher King
BACKGROUND: Vascular access is essential in managing patients with significant injuries. It is required for medications, fluids, blood products, and radiographic contrast administration. Generally, this is accomplished through peripheral intravenous (i.v.) cannulation. In some patients, however, i.v. cannulation may be difficult or impossible. Intraosseous (i.o.) access is an acceptable alternative for many uses during resuscitation. However, adequacy of vascular enhancement with i.o...
November 2015: Journal of Emergency Medicine
Ramin Mazaheri-Khameneh, Farshid Sarrafzadeh-Rezaei, Siamak Asri-Rezaei, Bahram Dalir-Naghadeh
This prospective study aimed to compare the intraosseous (IO) and intravenous (IV) effects of propofol on selected blood parameters and physiological variables during general anesthesia in rabbits. Thirty New Zealand White rabbits were studied. Six rabbits received IV propofol (group 1) and another 6 rabbits, were injected propofol intraosseously (Group 2) for 30 minutes (experimental groups). Rabbits of the third and fourth groups received IV and IO normal saline at the same volume given to the experimental groups, respectively...
2012: Veterinary Research Forum
Matthew Hansen, Garth Meckler, Caitlyn Dickinson, Kathryn Dickenson, Jonathan Jui, William Lambert, Jeanne-Marie Guise
OBJECTIVE: Emergency medical services (EMS) providers may have critical knowledge gaps in pediatric care due to lack of exposure and training. There is currently little evidence to guide educators to the knowledge gaps that most need to be addressed to improve patient safety. The objective of this study was to identify educational needs of EMS providers related to pediatric care in various domains in order to inform development of curricula. METHODS: The Children's Safety Initiative-EMS performed a three-phase Delphi survey on patient safety in pediatric emergencies among providers and content experts in pediatric emergency care, including physicians, nurses, and prehospital providers of all levels...
April 2015: Prehospital Emergency Care
Lara Erdmann, Sara Doll, Brit Ihle, Joachim Kirsch, Till S Mutzbauer
OBJECTIVE: To evaluate 2 sternal intraosseous access devices as alternatives to emergency intravenous access for dentists, using a manikin and a cadaver model. STUDY DESIGN: A group of 37 students performed a sternal intraosseous access on a manikin using a Vidacare kit including a puncture template and a prepuncture skin incision. Five months later, 9 of the students used the Vidacare and 8 used an Illinois needle (without template and incision) on adult human cadavers...
December 2013: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Michael Dolister, Stephen Miller, Stephen Borron, Edward Truemper, Manoj Shah, Muriel R Lanford, Thomas E Philbeck
PURPOSE: Central venous catheters (CVCs) are often placed to resuscitate unstable emergency department (ED) patients. In an observational study, we assessed intraosseous (IO) vascular access in the hospital, and compared results to published experiences with CVC placement. 
 METHODS: Patients who would typically receive a CVC were considered for the study. Vascular access was gained using a powered IO device. Data collection included placement success, placement time, ease-of-use, satisfaction with flow rates, complications and subsequent CVC placement...
July 2013: Journal of Vascular Access
Mathias Zuercher, Karl B Kern, Julia H Indik, Michael Loedl, Ronald W Hilwig, Wolfgang Ummenhofer, Robert A Berg, Gordon A Ewy
BACKGROUND: Vasopressors administered IV late during resuscitation efforts fail to improve survival. Intraosseous (IO) access can provide a route for earlier administration. We hypothesized that IO epinephrine after 1 minute of cardiopulmonary resuscitation (CPR) (an "optimal" IO scenario) after 10 minutes of untreated ventricular fibrillation (VF) cardiac arrest would improve outcome in comparison with either IV epinephrine after 8 minutes of CPR (a "realistic" IV scenario) or placebo controls with no epinephrine...
April 2011: Anesthesia and Analgesia
Timothy J Mader, Adam R Kellogg, Joshua K Walterscheid, Cynthia C Lodding, Lawrence D Sherman
BACKGROUND: Cardiocerebral resuscitation (CCR) is reportedly superior to cardiopulmonary resuscitation (CPR) for primary cardiac arrest in the prehospital setting. This study was done using a swine model of prolonged ventricular fibrillation (VF) to quantify the effect of the emergency medical services component of CCR with intraosseous access (CCR-IO) compared with standard CPR with intravenous access (CPR-IV) as it is typically performed during out-of-hospital cardiac arrest (OHCA) resuscitation in a prospective randomized fashion...
May 2010: Resuscitation
Lionel Lamhaut, Christelle Dagron, Roxana Apriotesei, Jérome Gouvernaire, Caroline Elie, Jean-Sébastien Marx, Caroline Télion, Benoît Vivien, Pierre Carli
INTRODUCTION: Rapid intravascular access is a prerequisite component of emergency care and resuscitation. Peripheral intravenous (IV) access is the first-choice for most of the medical or trauma patients, but may be delayed in emergency conditions because of various difficulties. Elsewhere, intraosseous (IO) access may now be easily performed with a new semi-automatic battery-powered IO-insertion device (EZ-IO. The aim of this study was to compare the overall time to establish IO infusion with the EZ-IO device and the equivalent time for peripheral IV infusion, performed by emergency personnel in standard (No-CBRN) and in chemical, biological, radiological, and nuclear (CBRN) protective equipment...
January 2010: Resuscitation
Daniel D Von Hoff, John G Kuhn, Howard A Burris, Larry J Miller
STUDY OBJECTIVE: Despite the growing popularity of intraosseous infusion for adults in emergency medicine, to date there has been little research on the pharmacokinetics of intraosseously administered medications in humans. The objective of the study was to compare the pharmacokinetics of intraosseous vs intravenous administration of morphine sulfate in adults. METHODS: The study followed a prospective, randomized, crossover design. Each subject was equipped with an indwelling intraosseous access device and an intravenous line...
January 2008: American Journal of Emergency Medicine
Joe Suyama, Christian C Knutsen, William E Northington, Michael Hahn, David Hostler
OBJECTIVE: Determine the time difference obtaining intraosseous (IO) versus intravenous (IV) access while wearing personal protective equipment (PPE) in simulated HazMat scenarios. METHODS: Twenty-two EMT-P providers established anterior tibial IO access using the EZ-IO system and routine antecubital IV access in three mannequin and PPE HazMat scenarios: 1) provider and mannequin not in PPE, 2) only provider in Level C PPE, and 3) provider and mannequin both wearing Level C PPE...
October 2007: Prehospital Emergency Care
Ralph J Frascone, Joe P Jensen, Kory Kaye, Joshua G Salzman
OBJECTIVE: Establishing traditional intravenous (IV) access in adult trauma and medical patients can be difficult. We evaluated provider performance for obtaining intraosseous access with two FDA-approved intraosseous devices (F.A.S.T.1 and EZ-IO) in two sequential field trials. METHODS: One hundred twenty-four providers consented to participate in the first field trial evaluating the use of the F.A.S.T.1 system. Three hundred eighty-nine providers consented to participate in the second field trial, evaluating the use of the EZ-IO...
April 2007: Prehospital Emergency Care
M Helm, J Hauke, N Bippus, L Lampl
INTRODUCTION: The intraosseous puncture (IO) is a fast and safe alternative to the puncture of peripheral veins in emergency situations in children < or =6 years of age. The purpose of this paper is to summarize 10 years of experience on the prehospital use of the IO method by the Helicopter Emergency Medical Service (HEMS) "Christoph 22", Ulm. MATERIALS AND METHODS: This was a retrospective study from 1 January 1996 to 31 December 2005. RESULTS: Out of a total of 9,549 missions, the proportion of children was 11...
January 2007: Der Anaesthesist
V Wenzel, K H Lindner, S Augenstein, W Voelckel, H U Strohmenger, A W Prengel, G Steinbach
OBJECTIVE: Intravenous administration of vasopressin during cardiopulmonary resuscitation (CPR) may be more effective than optimal doses of epinephrine. The main purpose of this study was to determine whether intraosseous vasopressin achieves serum drug levels comparable with intravenous doses during CPR and, additionally, to evaluate the effects of intraosseous vasopressin during CPR. DESIGN: Prospective, randomized laboratory investigation using an established porcine model with instrumentation for measurement of hemodynamic variables, blood gases, and return of spontaneous circulation...
August 1999: Critical Care Medicine
M I Herman, P A Chyka, A Y Butler, S E Rieger
Intraosseous administration of methylene blue may be an emergency alternative to intravascular administration. A 6-week-old female infant (3 kg) presented to the emergency department after a 1-week illness and appeared cyanotic and listless. Oxygen saturation by oximetry was 86% while the patient was receiving oxygen. Vital signs were blood pressure, 107/80 mm Hg; pulse, 190; respirations, 47; temperature, 39.0 degreesC. A metabolic acidosis and a methemoglobin level of 29.3% were present. After several unsuccessful attempts to establish intravenous access, an intraosseous needle was placed in the infant's left tibia...
January 1999: Annals of Emergency Medicine
S Banerjee, S C Singhi, S Singh, M Singh
It is sometimes difficult to gain a rapid intravenous access in hypovolemic states. The suitability of intraosseous (IO) route for fluid infusion as an effective, safe and reliable alternative to intravenous (IV) route was explored. Sixty children (age range 3 months to 2 years) with severe dehydration were assigned alternately to receive resuscitating fluid through either IO or IV routes. The IO route was successfully secured in all cases within the first 5 minutes of attempt. On the other hand, the IV line could not be secured in 33% (10 out of 30) patients within 5 minutes...
December 1994: Indian Pediatrics
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