Summary of “Journal Article Synopsis: Intraosseous Versus Intravenous Vascular Access During Out-of-Hospital Cardiac Arrest: A Randomized Controlled Trial,” Reades, Rosalyn, MD; Studnek, Jonathan R., PhD, NREMT-P; Vandeventer, Steven, EMT-P; Garret, John, MD. Annals of Emergency Medicine. 2011 Aug 17. [Epub ahead of print]
What is already known on this topic:
Intraosseous vascular access was originally used mainly in children. However, it has recently been shown that this method is also a rapid and effective way to obtain vascular access in the adult population, especially when a peripheral intravenous line fails. Therefore, this technique is used commonly in out-of-hospital settings when rapid vascular access is needed during cardiac arrest. Emergency Medical Services (EMS) protocols in the US list sternal, humeral, and tibial locations as available sites for intraosseous vascular access.
What question this study addressed:
The humeral and tibial locations are better sites during cardiac arrest due to constant chest compressions. However, data regarding the effectiveness of the humeral site versus the tibial site are limited. This study assessed the frequency of first-attempt success between humeral intraosseous, tibial intraosseous, and peripheral intravenous routes during out-of hospital cardiac arrest.
What was the study design:
This study was a prospective, nonblinded, triple-arm, randomized control trial of 182 adult patients over 18 years of age experiencing a non-traumatic out-of-hospital cardiac arrest in which resuscitation was initiated. Patients were randomized to one of 3 vascular access routes: tibial intraosseous, humeral intraosseous, or peripheral intravenous. Paramedics received extensive training in each method. The outcome measure was first-attempt success, defined as secure needle position in the marrow cavity or a peripheral vein with normal fluid flow. If a needle dislodged, it was considered a failure.
What this study adds to our knowledge:
Tibial intraosseous vascular access was determined to be the optimal method with regards to highest success rate and fastest time to access. However, peripheral intravenous access was associated with a higher volume of infused fluid.
How this is relevant to clinical practice:
Tibial intraosseous vascular access is beneficial for patients in who are in cardiac arrest or unconscious and who are unlikely to need large-volume fluid resuscitation. Its location is more removed from the primary site of resuscitation efforts, and is generally not beneath large amounts of soft tissue.
Other considerations:
The cost of intraosseous vascular access is much greater than the cost of peripheral intravenous vascular access. Further studies should be conducted to determine the cost effectiveness of tibial intraosseous over peripheral intravenous access.