Semiautomatic Intraosseous Devices in Pediatric Prehospital Care

Abstract

Background. Intraosseous (IO) access is attempted when intravenous access cannot be established during an emergency. The U.S. Food and Drug Administration–cleared semiautomatic IO access device (EZ-IO; Vidacare Corp., Shavano Park, TX) has been shown to be safe and effective. Objective. To examine the characteristics of pediatric patients receiving IO infusions, primary clinical impressions of emergency medical services providers, success rates, and subsequent treatment after use of a manual IO device or the semiautomatic IO device. Methods. A midwestern, 12-site, statewide ambulance service began using the semiautomatic device instead of a manual IO device in 2007. Retrospective review included analysis of device placement rates and subsequent treatment of children (younger than 18 years) who underwent an IO access procedure with either the manual device (January 2003 through February 2007) or the semiautomatic device (March 2007 through May 2009). Results. First-attempt success was achieved in 80.6% of patients (25 of 31) in the manual device group and in 83.9% of patients (52 of 62) in the semiautomatic device group (p = 0.98). In the manual device group, there were 37 attempts for 25 successful device placements (67.6% success), and in the semiautomatic group, there were 72 attempts for 58 successful placements (80.6% success) (p = 0.52). Intravenous attempts were made before IO attempts in 35.5% of patients (11 of 31) in the manual group and in 1.7% of patients (1 of 60) in the semiautomatic group (p < 0.001). Treatment (medication use, excluding lidocaine for local anesthetic purposes and intravenous crystalloid) was administered IO in 84.0% of the patients (21 of 25) in the manual device group and in 73.2% of the patients (41 of 56) in the semiautomatic device group. Conclusions. For the pediatric cohort, use of a semiautomatic IO access device in place of a manual device offered no statistically significant difference in first-attempt success (3.3%) or in success per attempt (13.0%). However, the rate at which IO access was used by emergency medical services providers more than tripled with use of the semiautomatic device.