Saving the critically injured trauma patient: a retrospective analysis of 1000 uses of intraosseous access.

OBJECTIVES & BACKGROUND: Intraosseous (IO) access is becoming increasingly accepted in adult populations as an alternative to peripheral vascular access, however there is still insufficient evidence in large patient groups supporting its use.

METHODS: Retrospective review. This paper reports on the use of intraosseous devices over a 7 year period from August 2006 to August 2013 during combat operations in Afghanistan. A search of the Joint Theatre Trauma Registry (JTTR-UK), a database of all trauma patients treated by Defence Medical Services in Iraq and Afghanistan, was carried out looking for all the incidences of intraosseous access use during this time. Adults were defined as patients aged 17 or above. Patient demographics, injuries, treatments and complications were retrieved. The results were collated and analysed using Excel TM (Microsoft).

RESULTS: 1014 intraosseous devices were used in 830 adult patients with no major complications. The rate of minor complications, the majority of which were device failure, was 1.38%. 5124 separate infusions of blood products or fluids occurred via intraosseous access, with 36% being of packed red cells. On average each casualty received 6.95 different infusions of blood products and fluids, and 3.28 separate infusions of drugs through intraosseous access. 32 different drugs were infused to 367 patients via IO, the most frequent being anaesthetic agents. Intraosseous access was used in the pre-hospital environment, during tactical helicopter evacuation and within hospitals.

CONCLUSION: Intraosseous access can be used for the infusion of a wide variety life saving medications, quickly, easily with low complication rates. This highlights its valuable role as an alternative method of obtaining vascular access, vital when resuscitating the critically injured trauma patient.