Comparison of intravenous and intraosseous access by pre-hospital medical emergency personnel with and without CBRN protective equipment.
BACKGROUND
Rapid intravascular access is a prerequisite component of emergency care and resuscitation. Peripheral intravenous (IV) access is the first-choice for most of the medical or trauma patients, but may be delayed in emergency conditions because of various difficulties. Elsewhere, intraosseous (IO) access may now be easily performed with a new semi-automatic battery-powered IO-insertion device (EZ-IO. The aim of this study was to compare the overall time to establish IO infusion with the EZ-IO device and the equivalent time for peripheral IV infusion, performed by emergency personnel in standard (No-CBRN) and in chemical, biological, radiological, and nuclear (CBRN) protective equipment.


METHODS
Nine nurses and 16 physicians randomly performed 4 procedures on a training manikin: IV and IO access under No-CBRN conditions and IV and IO under CBRN conditions. The time for each infusion attempt included all the steps essential for a simulated safe clinical use of infusion.


RESULTS
Under No-CBRN conditions, the time to establish IO infusion was shorter than the equivalent IV time (50+/-9 vs 70+/-30s). Similarly, under CBRN conditions, the time for IO infusion was shorter than for IV infusion (65+/-17 vs 104+/-30s). The mean time saved by IO infusion over IV infusion was respectively 20+/-24s (P<0.001) and 39+/-20s (P<0.001) under No-CBRN and CBRN conditions.


CONCLUSIONS
The time to establish IO infusion was significantly shorter than that for peripheral IV infusion, under both No-CBRN and CBRN conditions. Further clinical studies are required to confirm that IO access would effectively save time over IV access in real pre-hospital emergency settings.
SAMU de Paris, Département d'Anesthésie-Réanimation-SAMU, Hôpital Necker - Enfants Malades, 149 rue de Sèvres, 75730 Paris Cedex 15, Université Paris Descartes - Paris V, France.
Lionel
L
Lamhaut
Christelle
C
Dagron
Roxana
R
Apriotesei
Jérome
J
Gouvernaire
Caroline
C
Elie
Jean-Sébastien
JS
Marx
Caroline
C
Télion
Benoît
B
Vivien
Pierre
P
Carli
D004632:Emergency Medical Services / Q000379:methods*; D004635:Emergency Medicine / Q000193:education*; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D017148:Infusions, Intraosseous / Q000295:instrumentation*; D007262:Infusions, Intravenous / Q000295:instrumentation*; D007318:Inservice Training; D008348:Manikins; D011482:Protective Devices; D013997:Time Factors