title: An observational, prospective study comparing tibial and humeral intraosseous access using the EZ-IO.
abstract: BACKGROUND
  Intraosseous (IO) access is an alternative to conventional intravenous access. The proximal tibia and proximal humerus have been proposed as suitable sites for IO access.
  
  
  METHODS
  A nonrandomized, prospective, observational study comparing flow rates and insertion success with tibial and humeral IO access in adults using the EZ-IO-powered drill device was conducted. The tibia was the first site of insertion, and a second IO was inserted in the humerus if clinically indicated for the same patient.
  
  
  RESULTS
  Twenty-four patients were recruited, with 24 tibial and 11 humeral insertions. All EZ-IO insertions were successful at the first attempt except for 1 tibial insertion that was successful on the second attempt. All insertions were achieved within 20 seconds. Mean ease of IO insertion score (1=easiest to 10=most difficult) was 1.1 for both sites. We found tibial flow rates to be significantly faster using a pressure bag (165 mL/min) compared with those achieved without a pressure bag (73 mL/min), with a difference of 92 mL/min (95% confidence interval [CI]: 52, 132). Similarly, humeral flow rates were significantly faster using a pressure bag (153 mL/min) compared with humeral those achieved without pressure bag (84 mL/min), with a difference of 69 mL/min (95% CI: 39, 99). Comparing matched pairs (same patient), there was no significant difference in flow rates between tibial and humeral sites, with or without pressure bag infusion.
  
  
  CONCLUSIONS
  Both sites had high-insertion success rates. Flow rates were significantly faster with a pressure bag infusion than without. However, we did not find any significant difference in tibial or humeral flow rates.
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore. Electronic address: marcus.ong.e.h@sgh.com.sg.
authors.forename: Marcus Eng Hock
authors.initials: MEH
authors.lastname: Ong
authors.affiliation: Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Yiong Huak
authors.initials: YH
authors.lastname: Chan
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore.
authors.forename: Jen Jen
authors.initials: JJ
authors.lastname: Oh
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore.
authors.forename: Adeline Su-Yin
authors.initials: AS
authors.lastname: Ngo
mesh_terms: D000293:Adolescent; D000328:Adult; D004867:Equipment Design; D005260:Female; D006801:Humans; D006811:Humerus; D017148:Infusions, Intraosseous / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012151:Resuscitation / Q000295:instrumentation*; D013977:Tibia; D055815:Young Adult