Intraosseous devices: a randomized controlled trial comparing three intraosseous devices.

Area of Science:

• Emergency Medicine
• Trauma Care
• Vascular Access

Background:

• Intraosseous (IO) infusion is a critical alternative for rapid vascular access when intravenous (IV) access fails in emergencies.
• Recent advancements have introduced new IO devices like the Bone Injection Gun (BIG) and FAST1, renewing interest in this method.
• Effective circulation access is paramount for timely treatment in critical medical situations.

Purpose of the Study:

• To compare the efficacy and safety of different intraosseous needles for emergency vascular access in prehospital settings.
• To determine the preferable IO needle for acute fluid and medication administration in patients requiring immediate circulatory access.

Main Methods:

• A single-blind prospective randomized trial involving helicopter emergency medical services (HEMS) nurses.
• Comparison of Jamshidi 15G, BIG 15G/18G, and FAST1 needles in adult and pediatric patients requiring emergency vascular access.
• Evaluation metrics included insertion time, success rate, bone marrow aspiration, adverse events, and user satisfaction.

Main Results:

• The Jamshidi 15G showed significantly faster median insertion times (38 seconds) compared to FAST1 (62 seconds) (p = 0.004).
• Overall success rates were comparable: 80% in adults and 86% in children.
• No significant differences were found in complication rates or user satisfaction among the tested IO devices.

Conclusions:

• The Jamshidi 15G needle offers a faster insertion time compared to the FAST1.
• All evaluated intraosseous devices provide safe, simple, and effective means of achieving circulatory access in emergencies.
• IO infusion remains a valuable technique for critical care when IV access is challenging.