Set-Up Times, Infusion Times, and User Evaluations of Three Pressurized Intraosseous Infusion Devices

Hemorrhage is the leading cause of preventable battlefield death, and rapid whole blood transfusion is lifesaving. IV access is often difficult or unobtainable in hemorrhagic shock. Tactical Combat Casualty Care (TCCC) currently recommends intraosseous (IO) access for difficult vascular access scenarios and use of a pressure bag for IO blood infusion. However, comparative data on IO infusion speed and user experience with different IO infusion techniques is lacking.

This study evaluated 64 military medical personnel (32 Corpsmen, 32 Special Operations medics) in a mannequin-based IO simulation model. Participants intraosseously infused 2 units of simulated blood using three techniques-pressure bag, push-pull, and hand bulb. Primary outcomes included infusion time (set-up, infusion phases, and total) and user ratings on ease of use, confidence, construction reliability, low-light usability, one-handed operation, combat readiness, and preference.

Results showed the total time from set-up to completion of the second infusion was significantly slower for pressure bag (Corpsmen: 727s, 95% CI 671-783; Special Operations Forces (SOF) medics: 762s, 95% CI 685-838) than both the push-pull (Corpsmen: 505s, 95% CI 455-556; SOF medics: 457s, 95% CI 26-488, each p<.0001) and hand bulb (Corpsmen: 568s, 95% CI 504-633; SOF medics: 487s, 95% CI 452-522, each P<.0001). This pattern was similar at each of the four phases (each P<.05 or less).

These findings indicate the need for improved methods of pressurized IO infusion in combat care settings.