The Safety of Bolus Infusion Through Intraosseous Access Using the EZ-IO in Terms of Extraosseous Flow

다국어 초록 (Multilingual Abstract)

Purpose: We evaluated the safety of bolus infusion through intraosseous access using the EZ-IO in adults in terms of extraosseous flow.
Methods: We conducted a prospective study of adults (over age 18) in whom intraosseous access through the tibia was performed by emergency physicians or residents from June 2010 to June 2011. We used ultrasonography to confirm extraosseous flow during infusion of 80 mL normal saline with a 4 mL/s flow rate through intraosseous access,immediately after confirmation of intraosseous needle insertion using conventional methods. Finally, we recorded any complications that occurred immediately in the area of intraosseous access.
Results: Of 30 patients enrolled in the study, 22(73.3%)were male and eight (26.7%) were female. The mean age of study participants was 62.78±15.68 years; mean cortical thickness of participants’ tibias was 0.27±0.03 cm. The mean time required for performance of the intraosseous access procedure was 16.00±4.65 s; success rate on the first attempt, 100.0%. No immediate complications, including swelling or extraosseous flow at the area of intraosseous access, were observed.
Conclusion: In this study, bolus infusion though intraosseous access using the EZ-IO in adults in emergency departments was a safe option in terms of extraosseous flow.

참고문헌 (Reference)

1 Stone MB, "Ultrasonographic confirmation of intraosseous needle placement in an adult unembalmed cadaver model" 49 : 515-519, 2007

2 Schwartz D, "The use of a powered device for intraosseous drug and normal saline administration in a national EMS: a 4-year experience" 64 : 650-654, 2008

3 Seigler RS, "Prehospital intraosseous infusion by emergency medical services personnel: a prospective study" 84 : 173-177, 1989

4 Gillum L, "Powered intraosseous access in the prehospital setting: MCHD EMS puts the EZ-IO to the test" 30 (30): 24-25, 2005

5 Iserson KV, "Intraosseous infusions in adults" 7 : 587-591, 1989

6 Rosetti VA, "Intraosseous infusion: an alternative route of pediatric intravascular access [review]" 14 : 885-888, 1985

7 Fiser DH, "Intraosseous infusion" 322 : 1579-1581, 1990

8 Simmons CM, "Intraosseous extravasation flow complication reports" 23 : 363-366, 1994

9 Luck RP, "Intraosseous Access?" 39 : 468-475, 2010

10 Alam HB, "Hypertonic saline: intraosseous infusion causes myonecrosis in a dehydrated swine model of uncontrolled hemorrhagic shock" 52 : 18-25, 2002

11 Glaeser P, "Five-year experience in prehospital intraosseous infusions in children and adults" 22 : 1119-1124, 1993

12 Tsung JW, "Feasibility of point-ofcare ultrasonography confirmation of intraosseous needle placement during resuscitation" 80 : 665-668, 2009

13 LaSpada J, "Extravasation rates and complications of intraosseous needles during gravity and pressure infusion" 23 : 2023-2028, 1995

14 Olsen D, "Evaluation of the bone injection gun as a method for intraosseous cannula placement for normal saline therapy in adult dogs" 31 : 533-540, 2002

15 Biarent D, "European Resuscitation Council Guidelines for Resuscitation 2010 Section 6. Paediatric life support" 81 : 1364-1388, 2010

16 Gazin N, "Efficacy and safety of the EZ-IOTM intraosseous device: Out-of-hospital implementation of a management algorithm for difficult vascular access" 82 : 126-129, 2011

17 Rossetti V, "Difficulty and delay in intravascular access in pediatric arrests" 13 : 406-, 1984

18 Moscati R, "Compartment syndrome with resultant amputation following intraosseous infusion" 8 : 470-471, 1990

19 Waisman M, "Bone marrow infusion in adults" 42 : 288-293, 1997

20 Brickman KR, "Analysis of growth plate abnormalities following intraosseous infusion through the proximal tibial epiphysis in pigs" 17 : 121-123, 1988

21 Macnab A, "A new system for sternal intraosseous infusion in adults" 4 : 173-177, 2000

22 안기옥, "1급 응급구조사의 드릴형 골내 주사의 병원전 사용에 대한 교육 효과 평가" 대한응급의학회 19 (19): 611-616, 2008