374 User Characteristics of Six Intraosseous Devices in a High Bone Density Humerus and Sternum Cadaveric Swine (Sus Scrofa) Model

Abstract

Intraosseous (IO) infusion, the pressurized injection of fluids into bone through a catheter, is a life-preserving resuscitative technique for treating critical care patients and trauma patients with severe hemorrhage. To be effective as a bridge to central venous access, IO infusion flow rates must be sufficient to sustain life but at pressures low enough to avoid complications. However, little is known regarding end user characteristics of available battery-powered and manual IO devices. User characteristics are important, because to be efficient and effective, an IO device should optimally have a minimal set-up (placement) time and be perceived as easy and comfortable to use, resistant to bending and displacement, effective and trustworthy in meeting the demands of rapid resuscitation, and cause minimal hand fatigue. The present study was specifically designed to fill this important gap in the literature. Three experienced emergency medicine residents each inserted a variety of commercially available 15-gauge IO catheters in cadaveric swine (Sus scrofa) proximal humeri and sternums with bone density similar to adult humans (1.0-1.1 gm/cm2) in a randomized prospective experimental design, and then infused 500 cc of isotonic crystalloid using push-pull technique with a 60cc syringe. Devices included the battery-powered EZ-IO Rapid Infuser and the manual Jamshidi IO, Persys NIO, SAM Manual IO, Tactical Advanced Lifesaving IO Needle (TALON), and PYNG FASTR devices (30 trials per device, 10 per user). Pressures were measured using an in-line manometer. Subjective user characteristics were assessed across eight Likert-type items, which were analyzed individually and as a composite score. Objective and user ratings data were analyzed using ANOVA and nonparametric statistics at p<.05. Infusion flow rates, mean pressures, and peak pressures were generally similar across devices and locations, save that the TALON in the sternum conferred roughly 50% higher flow rates at 30% lower mean pressures and 15% lower peak pressures than other devices in sternum or humerus (each p<.0001). The EZ-IO demonstrated the fastest set-up times and the highest composite user ratings (Figure 1), including highest ratings for each of the eight survey items (p<.0001). The TALON conferred intermediate set-up times and next-highest user ratings overall. The Jamshidi had the longest set-up times, the slowest infusion rates, and relatively low user ratings. IO access devices differ in construction, method of application, effectiveness, and user characteristics. The commonly used battery-powered EZ-IO had the fastest set-up times and the highest user ratings. While the present study was limited by the utilization of a cadaveric swine model rather than an in vivo model, findings suggest the possibility that the TALON, which performed well in objective assessments and user ratings, may be worth considering as a manual backup to the battery-operated EZ-IO Rapid Infuser. Combined, these results highlight the importance of studying the end user characteristics of IO infusion devices towards preserving the lives of critically ill or injured patients requiring rapid fluid or blood product resuscitation.