title: EZ-IO(®) intraosseous device implementation in German Helicopter Emergency Medical Service.
abstract: BACKGROUND
  Intraosseous access (IO) is a rapid and safe alternative when peripheral venous access is difficult. Our aim was to summarize the first three years experience with the use of a semi-automatic IO device (EZ-IO(®)) in German Helicopter Emergency Medical Service (HEMS).
  
  
  METHODS
  Included were all patients during study period (January 2009-December 2011) requiring an IO access performed by HEMS team. Outcome variables were IO rate, IO insertion success rates, site of IO access, type of EZ-IO(®) needle set used, strategy of vascular access, procedure related problems and operator's satisfaction.
  
  
  RESULTS
  IO rate was 0.3% (348/120.923). Overall success rate was 99.6% with a first attempt success rate of 85.9%; there was only one failure (0.4%). There were three insertion sites: proximal tibia (87.2%), distal tibia (7.5%) and proximal humerus (5.3%). Within total study group IO was predominantly the second-line strategy (39% vs. 61%, p<0.001), but in children<7 years, in trauma cases and in cardiac arrest IO was more often first-line strategy (64% vs. 28%, p<0.001; 48% vs. 34%, p<0.032; 50% vs. 29%, p<0.002 respectively). Patients with IO access were significantly younger (41.7±28.7 vs. 56.5±24.4 years; p<0.001), more often male (63.2% vs. 57.7%; p=0.037), included more trauma cases (37.3% vs. 30.0%; p=0.003) and more often patients with a NACA-Score≥5 rating (77.0% vs. 18.6%; p<0.001). Patients who required IO access generally presented with more severely compromised vital signs associated with the need for more invasive resuscitation actions such as intubation, chest drains, CPR and defibrillation. In 93% EZ-IO(®) needle set handling was rated "good". Problems were reported in 1.6% (needle dislocation 0.8%, needle bending 0.4% and parafusion 0.4%).
  
  
  CONCLUSIONS
  The IO route was generally used in the most critically ill of patients. Our relatively low rate of usage would indicate that this would be compatible with the recommendations of established guidelines. The EZ-IO(®) intraosseous device proved feasible with a high success rate in adult and pediatric emergency patients in HEMS.
authors.affiliation: Department of Anaesthesiology & Intensive Care Medicine - Section Emergency Medicine/HEMS "Christoph 22", Armed Forces Medical Centre Ulm, Germany. Electronic address: matthias.helm@extern.uni-ulm.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Helm
authors.affiliation: Department of Anaesthesiology & Intensive Care Medicine - Section Emergency Medicine/HEMS "Christoph 22", Armed Forces Medical Centre Ulm, Germany.
authors.forename: Benedikt
authors.initials: B
authors.lastname: Haunstein
authors.affiliation: Medical Quality Management - ADAC Luftrettung (Subsidiary of the German Automobile Association), Munich, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schlechtriemen
authors.affiliation: Department of Medicine - ADAC Luftrettung (Subsidiary of the German Automobile Association), Munich, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Ruppert
authors.affiliation: Department of Anaesthesiology & Intensive Care Medicine - Section Emergency Medicine/HEMS "Christoph 22", Armed Forces Medical Centre Ulm, Germany.
authors.forename: Lorenz
authors.initials: L
authors.lastname: Lampl
authors.affiliation: Department of Medicine - ADAC Luftrettung (Subsidiary of the German Automobile Association), Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Gäßler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000401:Aircraft; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005858:Germany; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007267:Injections / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012151:Resuscitation / Q000295:instrumentation*; D012189:Retrospective Studies; D013977:Tibia; D055815:Young Adult
keywords: EZ-IO(®); Emergency medicine; Helicopter Emergency Medical Service; Intraosseous vascular access; Vascular access