Comparison of 4 Pediatric Intraosseous Access Devices: A Randomized Simulation Study

Area of Science:

• Emergency Medicine
• Medical Simulation
• Device Technology

Background:

• Intravascular access is challenging in emergencies.
• Intraosseous (IO) route offers a viable alternative for medication and fluid administration.
• IO access is well-established, particularly in critical care settings.

Purpose of the Study:

• To evaluate the efficacy of mechanical and manual intraosseous (IO) devices in novice physicians.
• To compare success rates and procedure times for different IO cannulation devices in a simulated pediatric setting.

Main Methods:

• Seventy-five novice physicians participated in a randomized simulation study.
• Participants were trained and then tested on identifying puncture sites and performing IO cannulation using BIG Pediatric, Arrow EZ-IO, NIO Pediatric (mechanical), and Jamshidi needle (manual) devices.
• Testing was performed on a pediatric manikin and turkey bone models.

Main Results:

• Sixty-eight participants successfully performed IO cannulations.
• First attempt success rates for mechanical devices were high (NIO Pediatric 100%, Arrow EZ-IO 97%, BIG Pediatric 90%), significantly outperforming the manual Jamshidi device (43%).
• Procedure times were faster with mechanical devices (18-23 seconds) compared to the manual device (34 seconds).

Conclusions:

• Mechanical IO devices show high efficacy and efficiency in simulated scenarios for novice users.
• Further clinical studies are required to validate these findings in real-world comparative settings.
• The success rates may vary with user experience levels.