title: Comparison of intraosseous versus central venous vascular access in adults under resuscitation in the emergency department with inaccessible peripheral veins.
abstract: BACKGROUND
  Current European Resuscitation Council (ERC) guidelines recommend intraosseous (IO) vascular access, if intravenous (IV) access is not readily available. Because central venous catheterisation (CVC) is an established alternative for in-hospital resuscitation, we compared IO access versus landmark-based CVC in adults with difficult peripheral veins.
  
  
  METHODS
  In this prospective observational study we investigated success rates on first attempt and procedure times of IO access versus central venous catheterisation (CVC) in adults (≥ 18 years of age) with inaccessible peripheral veins under trauma or medical resuscitation in a level I trauma centre emergency department.
  
  
  RESULTS
  Forty consecutive adults under resuscitation were analysed, each receiving IO access and CVC simultaneously. Success rates on first attempt were significantly higher for IO cannulation than CVC (85% versus 60%, p=0.024) and procedure times were significantly lower for IO access compared to CVC (2.0 versus 8.0 min, p<0.001). As for complications, failure of IO access was observed in 6 patients, while 2 or more attempts of CVC were necessary in 16 patients. No other relevant complications like infection, bleeding or pneumothorax were observed.
  
  
  CONCLUSIONS
  IO vascular access is a reliable bridging method to gain vascular access for in-hospital adult patients under resuscitation with difficult peripheral veins. Moreover, IO access is more efficacious with a higher success rate on first attempt and a lower procedure time compared to landmark-based CVC.
authors: Department of Emergency Medicine, Campus Benjamin Franklin, Charité - University Medical Centre, Berlin, Germany. bernd.a.leidel@charite.de
authors: Bernd A
authors: BA
authors: Leidel
authors: Chlodwig
authors: C
authors: Kirchhoff
authors: Viktoria
authors: V
authors: Bogner
authors: Volker
authors: V
authors: Braunstein
authors: Peter
authors: P
authors: Biberthaler
authors: Karl-Georg
authors: KG
authors: Kanz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy*; D006801:Humans; D017148:Infusions, Intraosseous / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications / Q000628:therapy*; D011446:Prospective Studies; D012151:Resuscitation / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult