title: Current advances in intraosseous infusion - a systematic review.
abstract: OBJECTIVE
  To describe the advancement of Intraosseous (IO) infusion in the spectrum of resuscitative protocols and to provide a systematic review on currently used semi-automatic IO infusion devices. The specific question addressed was: "In patients undergoing resuscitation, does the use of semi-automatic IO infusion devices compared to manual needles influence IO placement success rate, time for IO placement, and ease-of-use and user preference?"
  
  
  METHODS
  The electronic databases PubMed and Embase were searched for articles published from 1997 to 2010 using the search terms ("intraosseous") AND ("needle" or "device" or "technique") AND ("infusion" or "injection" or "access"). The Internet search engine Google Scholar was searched using the search term "intraosseous infusion device" to identify articles published in electronic journals, books, and scientific websites. Articles were included only if they compared at least two types of semi-automatic devices, or compared one or more semi-automatic device with one or more manual needles. Reviews, editorials, surveys, and case reports were excluded.
  
  
  RESULTS
  The search strategy yielded 179 papers. Ten studies met full criteria for further review. Of these, two were LOE 1 (randomized controlled trials), one was LOE 2 (non-randomized, concurrent controls), one was LOE 3 (retrospective controls), and six were LOE 5 (simulation-based study). One of the six LOE 5 studies was a non-peer reviewed article.
  
  
  CONCLUSIONS
  Only a few studies compared the performance of different types of IO infusion devices, most of them have a low level of evidence. These studies suggested a superiority of the battery-powered IO driver over manual needles, and other semi-automatic IO infuson devices.
authors.affiliation: Emergency Department, Meyer Children's Hospital, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Giora
authors.initials: G
authors.lastname: Weiser
authors.forename: Yoav
authors.initials: Y
authors.lastname: Hoffmann
authors.forename: Roger
authors.initials: R
authors.lastname: Galbraith
authors.forename: Itai
authors.initials: I
authors.lastname: Shavit
mesh_terms: D002317:Cardiovascular Agents / Q000008:administration & dosage*; D004867:Equipment Design; D006801:Humans; D017148:Infusions, Intraosseous / Q000295:instrumentation*; D012151:Resuscitation / Q000379:methods*
chemical_list: D002317:Cardiovascular Agents