title: Intraosseous versus central venous catheter utilization and performance during inpatient medical emergencies.
abstract: OBJECTIVE
  Intraosseous access is a rapid and effective route of fluid and drug administration. Its use has been proven in emergency medicine, pediatrics, and the military. We aimed to assess its performance and utilization against landmark-guided central venous catheter placement during inpatient medical emergencies.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Eight hundred fifty-six-bed urban teaching hospital.
  
  
  METHODS
  Adult inpatients requiring central venous access during medical emergencies.
  
  
  METHODS
  Intraosseous device training was added to standard central venous catheter training beginning in February 2012. Intraosseous were used as primary access in cardiac arrests and secondary access if central venous catheter placement failed during noncardiac arrest emergencies. An online survey was conducted among intraosseous and central venous catheter operators to assess their experience and any barriers to use.
  
  
  RESULTS
  Seventy-nine adults had central access placement from February 2012 to July 2013. Sixty were during medical emergency team calls, and 19 were cardiac arrests. Thirty-one received intraosseous device, and 48 received a central venous catheter. First-pass success was significantly higher for intraosseous than for central venous catheter (90.3 vs 37.5%; 95% CI, 80-101 vs 24-51; p<0.001). Mean placement times were significantly shorter for intraosseous than for central venous catheter (1.2 vs 10.7 min; p<0.001). There were a total of 33 intraosseous versus 169 central venous catheter attempts with fewer attempts on average per patient during intraosseous placement (1.1 vs 2.8; p<0.001). There were three intraosseous-related complications and 22 central venous catheter-related complications. Our survey showed high satisfaction with intraosseous training and operation. Among the barriers cited, timely intraosseous kit acquisition was most common.
  
  
  CONCLUSIONS
  It is feasible to incorporate intraosseous use during medical emergency team calls. Intraosseous had significantly higher first-pass success rates and faster placement compared with central venous catheters. Intraosseous operators reported high satisfaction and confidence in its use. Prospective randomized studies comparing intraosseous and central venous catheter are warranted.
authors.affiliation: 1Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Mount Sinai Beth Israel Medical Center, Icahn School of Medicine, New York, NY. 2Department of Medicine, Mount Sinai Beth Israel Medical Center, Icahn School of Medicine, New York, NY. 3Division of Critical Care Medicine, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Peter M J
authors.initials: PM
authors.lastname: Lee
authors.forename: Christina
authors.initials: C
authors.lastname: Lee
authors.forename: Peter
authors.initials: P
authors.lastname: Rattner
authors.forename: Xiaoping
authors.initials: X
authors.lastname: Wu
authors.forename: Hayley
authors.initials: H
authors.lastname: Gershengorn
authors.forename: Samuel
authors.initials: S
authors.lastname: Acquah
mesh_terms: D062905:Central Venous Catheters / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D057209:Hospital Rapid Response Team / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching; D006801:Humans; D017148:Infusions, Intraosseous / Q000009:adverse effects / Q000379:methods*; D008297:Male; D011446:Prospective Studies