Intraosseous vascular access for in-hospital emergency use: a systematic clinical review of the literature and analysis.
Intraosseous (IO) vascular access is a viable primary alternative in patients requiring emergent vascular access in the hospital emergency department (ED) (eg, resuscitation, shock/septic shock) but is underutilized.


OBJECTIVE
This review has 3 objectives: (1) review the evidence supporting the use of IO access; (2) determine the utilization of IO access as described in the literature; and (3) assess the level of specialty society support.


METHODS
Electronic and hand searches were undertaken to identify relevant articles. English-language-only articles were identified. The Cochrane Review methodology along with data forms were used to collect and review data. The evidence evaluation process of the international consensus on emergency cardiovascular care was used to assess the evidence. Studies were combined where meta-analyses could be performed.


RESULTS
In levels 2 to 5 studies, IO access performed better versus alternative access methods on the end points of time to access and successful access. Complications appeared to be comparable to other venous access methods. Randomized controlled trials are lacking. Newer IO access technologies appear to do a better job of gaining successful access more quickly. Intraosseous access is underutilized in the ED because of lack of awareness, lack of guidelines/indications, proper training, and a lack of proper equipment.


CONCLUSIONS
Recommendations/guidelines from physician specialty societies involved in the ED setting are also lacking. Underutilization exists despite recommendations for IO access use from a number of important medical associations peripherally involved in the ED such as the American Academy of Pediatrics. To encourage the IO approach, IO product champions (as both supporter and user) in the ED are needed for prioritizing and assigning IO access use when warranted. In addition, specialty societies directly involved in emergent hospital care should develop clinical guidelines for IO use.
Medical Device Consultants of Ridgewood, Ridgewood, NJ, USA. meddevconsultant@aol.com
Jeffrey
J
Voigt
Mark
M
Waltzman
Lawrence
L
Lottenberg
D002408:Catheters, Indwelling / Q000009:adverse effects; D002986:Clinical Trials as Topic; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital; D019317:Evidence-Based Medicine; D006801:Humans; D006811:Humerus; D017148:Infusions, Intraosseous / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012955:Societies, Medical; D013977:Tibia