Complication with intraosseous access: scandinavian users' experience

Area of Science:

• Emergency Medicine
• Critical Care
• Resuscitation Techniques

Background:

• Intraosseous (IO) access is vital for rapid vascular access during resuscitation when conventional methods fail.
• Existing complication data for IO use is primarily from controlled studies, potentially underestimating real-world challenges.
• User experience in actual emergency scenarios may differ significantly from controlled settings.

Purpose of the Study:

• To assess user-reported complications associated with intraosseous access in real-life emergency situations.
• To compare perceived complication rates with existing literature from model and small patient studies.
• To evaluate the impact of user experience on the willingness to use IO access.

Main Methods:

• An online survey was distributed to emergency physicians, anesthesiologists, and pediatricians in Scandinavia.
• The survey collected data on 1,802 reported clinical cases of IO use.
• Responders detailed complications encountered during IO insertion and use.

Main Results:

• Common insertion complications included pain (7.1%), periosteal penetration difficulty (10.3%), bone marrow aspiration difficulty (12.3%), and needle bending/breaking (4.0%).
• Complications during use involved injection difficulties (7.4%), slow infusion (8.8%), displacement (8.5%), and extravasation (3.7%).
• Rare but serious complications like compartment syndrome (0.6%) and osteomyelitis (0.4%) were reported.

Conclusions:

• Perceived complication rates in real-life IO use are higher than typically reported in controlled studies.
• Difficulties encountered by users may influence the adoption and utilization of IO access.
• Enhanced user education and improved IO device design are recommended to address these challenges.