Emergency Vascular Access Research Articles

Implementation of advanced vascular access, physiological monitoring and goal-directed resuscitation during OHCA in a helicopter emergency medical service.

Outcomes after out-of-hospital cardiac arrest (OHCA) remain poor in the UK. In order to increase the chances of successful resuscitation, international society guidelines on cardiopulmonary resuscitation quality have recommended titration of chest compression parameters and vasopressor administration to arterial diastolic blood pressure if invasive catheters are in situ at the time of cardiac arrest. However, prehospital initiation of arterial and central venous catheterisation is seldom undertaken due to the risks and significant technical challenges in the context of ongoing resuscitation in this environment. In 2019, a dedicated programme was started at East Anglian Air Ambulance (EAAA) to enable the safe introduction of contemporary emergency vascular access devices, in order to improve physiological monitoring intra-arrest and deliver nuanced, goal-directed resuscitation in OHCA patients. This programme was entitled Specialist Percutaneous Emergency Aortic Resuscitation (SPEAR). This article details the EAAA SPEAR technique; and the development, implementation and governance of this novel endovascular strategy in our UK physician-paramedic staffed helicopter emergency medical service.

Pre-hospital emergency medicine: a spectrum of imaging findings.

The goal of emergency medical services (EMS) is to provide urgent medical care and stabilization prior to patient transport to a healthcare facility for definitive treatment. The number and variety of interventions performed in the field by EMS providers continues to grow as early management of severe injuries and critical illness in the pre-hospital setting has been shown to improve patient outcomes. The sequela of many field interventions, including those associated with airway management, emergent vascular access, cardiopulmonary resuscitation (CPR), patient immobilization, and hemorrhage control may be appreciated on emergency department admission imaging. Attention to these imaging findings is important for the emergency radiologist, who may be the first to identify a malpositioned device or an iatrogenic complication arising from pre-hospital treatment. Recognition of these findings may allow for earlier corrective action to be taken in the acute care setting. This review describes common EMS interventions and their imaging findings.

Factors influencing the success and complications of intraosseous access in pediatric patients—a prospective nationwide surveillance study in Germany

BackgroundVascular access is essential for the efficient treatment of critically ill children, but it can be difficult to obtain. Our study was conducted to analyze the feasibility and short-term safety of intraosseous access (IO) use as well as factors influencing its success and the incidence of complications in pediatric emergencies and resuscitation. This dataset of systematically documented intraosseous access attempts constitutes one of the largest published in the literature.MethodsTwo-year nationwide prospective surveillance study in Germany from July 2017 to June 2019. Pediatric hospitals anonymously reported the case data of all children aged 28 days to 18 years who arrived with or were treated with an intraosseous access to the German Pediatric Surveillance Unit (GPSU). The main outcomes were the occurrence of complications, overall success and success at the first attempt. The influence of individual factors on outcomes was evaluated using multivariate regression models.ResultsA total of 417 patients underwent 549 intraosseous access attempts. The overall rates of success and success at the first attempt were 98.3% and 81.9%, respectively. Approximately 63.6% of patients were successfully punctured within 3 min from the time of indication. Approximately 47.7% of IO access attempts required patient resuscitation. Dislocation [OR 17.74 (5.32, 59.15)] and other complications [OR 9.29 (2.65, 32.55)] occurred more frequently in the prehospital environment. A total of 22.7% of patients experienced minor complications, while 2.5% of patients experienced potentially severe complications.ConclusionWe conclude that intraosseous access is a commonly used method for establishing emergency vascular access in children, being associated with a low (age-dependent) rate of severe complications and providing mostly reliable vascular access despite a relatively high rate of dislocation.

Epidemiological Analysis of the Emergency Vascular Access in Pediatric Trauma Patients: Single-Center Experience of Intravenous, Intraosseous, Central Venous, and Arterial Line Placements

Vascular access in severely injured pediatric trauma patients is associated with time-critical circumstances and low incidences, whereas only scarce literature on procedure performance is available. The purpose of this study was to analyze the performance of different vascular access procedures from the first contact at the scene until three hours after admission. Intubated pediatric trauma patients admitted from the scene to a single Level I trauma center between 2008 and 2019 were analyzed regarding intravenous (IV) and intraosseous (IO) accesses, central venous catheterization (CVC) and arterial line placement. Sixty-five children with a median age of 14 years and median injury severity score of 29 points were included, of which 62 (96.6%) underwent successful prehospital IV or IO access by emergency medical service (EMS) physicians, while it failed in two children (3.1%). On emergency department (ED) admission, IV cannulas of prehospital EMS had malfunctions or were dislodged in seven of 55 children (12.7%). IO access was performed in 17 children without complications, and was associated with younger age, higher injury severity and higher mortality. Fifty-two CVC placements (58 attempts) and 55 arterial line placements (59 attempts) were performed in 45 and 52 children, respectively. All CVC and arterial line placements were performed in the ED, operating room (OR) and intensive care unit (ICU). Ten mechanical complications related to CVC placement (17.8%) and seven related to arterial line placement (10.2%) were observed, none of which had outcome-relevant consequences. This case series suggests that mechanical issues of vascular access may frequently occur, underlining the need for special preparedness in prehospital, ED, ICU and OR environments.

Clinical Management of Intraosseous Access in Adults in Critical Situations for Health Professionals.

There are health professionals who are unaware of the ideal management of the intraosseous route, despite the fact that it has been scientifically considered an alternative to the peripheral venous route when the patient is in critical condition. Thanks to continuous development, there has been a need to provide emergency services with materials that manage to provide satisfactory care, despite the difficulties faced by health personnel. Objectives: The objective of this systematic bibliographic review is to update the theoretical and practical knowledge and strategies for the insertion and proper management of the intraosseous route as an emergency vascular access for nursing professionals. Data sources, study eligibility criteria: The search for the articles was carried out in various scientific databases with the help of a search string (January 2015 and May 2021), which combined the keywords and Boolean operators. Study appraisal and synthesis methods: Eighteen articles were chosen after a review of 1920 database articles, following the application of the inclusion and exclusion criteria. Results: Intraosseous infusion is an effective and safe technique, which increases patient survival. Therefore, it is of crucial importance that all nursing professionals know how to handle the different intraosseous devices in situations in which it is not possible to achieve immediate peripheral venous access. Conclusions and implications of key findings: It is of great need to have devices or fast and effective alternatives that allow us to develop safe interventions by health professionals.

Comparison of intraosseous access and central venous catheterization in Chinese adult emergency patients: A prospective, multicenter, and randomized study

It is challenging to establish peripheral intravenous access in adult critically patients. This study aims to compare the success rate of the first attempt, procedure time, operator satisfaction with the used devices, pain score, and complications between intraosseous (IO) access and central venous catheterization (CVC) in critically ill Chinese patients. In this prospective clustered randomized controlled trial, eight hospitals were randomly divided into either the IO group or the CVC group. Patients who needed emergency vascular access were included. From April 1, 2017 to December 31, 2018, each center included 12 patients. We recorded the data mentioned above. A total of 96 patients were enrolled in the study. There were no statistically significant differences between the two groups regarding sex, age, body mass index, or operator satisfaction with the used devices. The success rates of the first attempt and the procedure time were statistically significant between the IO group and the CVC group (91.7% vs. 50.0%, P<0.001; 52.0 seconds vs. 900.0 seconds, P<0.001). During the study, 32 patients were conscious. There was no statistically significant difference between the two groups regarding the pain score associated with insertion. There were statistically significant differences between the two groups regarding the pain score associated with IO or CVC infusion (1.5 vs. 0.0, P=0.044). Complications were not observed in the two groups. IO access is a safe, rapid, and effective technique for gaining vascular access in critically ill adults with inaccessible peripheral veins in the emergency departments.

Use of Intraosseous Vascular Access During Neonatal Resuscitation at a Tertiary Center.

Introduction: Emergency vascular access is rarely required during neonatal resuscitation. We aimed to analyze frequency of use, success, and complication rates of intraosseous (IO) vascular access in neonates at a single tertiary neonatal intensive care unit.Method: We performed a questionnaire-based survey among pediatric residents, pediatricians, and neonatologists, asking for the use of IO access in neonates between April 1st, 2015, and April 30th, 2020. We then reviewed electronic patient charts of all identified neonates for demographic data as well as indications and complications of IO puncture.Results: All 41 questionnaires were answered. Nine physicians had attempted IO access 15 times in a total of 12 neonates. Among them were eight term neonates, three preterm neonates, and one former extreme preterm neonate at a post-menstrual age of 42 weeks (m:f = 6:6). The overall success rate was 75%. IO access was attempted primarily during post-natal resuscitation (11/12 neonates, 91.7%) and after unsuccessful peripheral venous puncture (8/12 neonates, 66.7%). It was used to administer adrenaline, fluid and/or blood, and emergency sedation after intubation. Minor short-term complications were reported in three of nine successful IO punctures (33.3%).Discussion: Over the study period of 61 months, IO access was rarely attempted during neonatal resuscitation. Our success rate was lower than reported elsewhere, suggesting that IO puncture may be more challenging in neonates than in older infants and children. No severe short-term complications occurred.

Effect of Teaching Sessions Implementation on Performance of Internship Nursing Students Regarding IntraOsseous Access

Context: Intraosseous (IO) access is an emergency vascular access for providing venous administration of drugs and fluids in emergencies. Nurses are responsible for preparing and administering fluids and medications through IO access so that nurses should be aware of IO indications, contraindications, complications, and also practicing Intraosseous (IO) access insertion.&#x0D; Aim: The current study was conducted to assess the effect of teaching sessions implementation on the performance of internship nursing students regarding intraosseous access.&#x0D; Methods: A quasi-experimental (pre/post-test) design was unitized to conduct this study. The study recruited a convenient sample of fifty (50) internship nursing students. The Critical care lab at Faculty of Nursing Ain Shams University was used to conduct the teaching sessions. The study used two tools to achieve the aim of this study; Intraosseous Access Self-Administered Questionnaire and Internship Nurses' Practice Observational Checklist regarding intraosseous access.&#x0D; Results: After teaching session implementation regarding intraosseous access, there were statistically significant improvements in the level of performance of internship nursing students at P &gt;0.05.&#x0D; Conclusion: Teaching session implementation had a statistically significant positive effect on internship nursing students' performance regarding intraosseous access. Repetitive training regarding IO access is recommended to be integrated as a part of the nursing faculty's clinical skills to ensure the highest standard of care in emergencies and to maximize skill retention.

Preparing Residents for Emergent Vascular Access: The Comparative Effectiveness of Central Venous and Intraosseous Catheter Simulation-Based Training

Preparing Residents for Emergent Vascular Access: The Comparative Effectiveness of Central Venous and Intraosseous Catheter Simulation-Based Training

Duration to Establish an Emergency Vascular Access and How to Accelerate It: A Simulation-Based Study Performed in Real-Life Neonatal Resuscitation Rooms.

To compare the duration to establish an umbilical venous catheter and an intraosseous access in real hospital delivery rooms and as a secondary aim to assess delaying factors during establishment and to provide recommendations to accelerate vascular access in neonatal resuscitation. Retrospective analysis of audio-video recorded neonatal simulation training. Simulation training events in exact replications of actual delivery/resuscitation rooms of 16 hospitals with different levels of care (Austria and Germany). Equipment was prepared the same way as for real clinical events. Medical teams of four to five persons with birth-related background (midwives, nurses, neonatologists, and anesthesiologists) in a realistic team composition. Audio-video recorded mannequin-based simulated resuscitation of an asphyxiated newborn including the establishment of either umbilical venous catheter or intraosseous access. The duration of access establishment (time from decision to first flush/aspiration), preparation (decision to start of procedure), and the procedure itself (start to first flush/aspiration) was significantly longer for umbilical venous catheter than for intraosseous access (overall duration 199 vs 86 s). Delaying factors for umbilical venous catheter establishment were mainly due to the complex approach itself, the multitude of equipment required, and uncertainties about necessary hygiene standards. Challenges in intraosseous access establishment were handling of the unfamiliar material and absence of an intraosseous access kit in the resuscitation room. There was no significant difference between the required duration for access establishment between large centers and small hospitals, but a trend was observed that duration for umbilical venous catheter was longer in small hospitals than in centers. Duration for intraosseous access was similar in both hospital types. Vascular access establishment in neonatal resuscitation could be accelerated by infrastructural improvements and specific training of medical teams. In simulated in situ neonatal resuscitation, intraosseous access is faster to establish than umbilical venous catheter. Future studies are required to assess efficacy and safety of both approaches in real resuscitation settings.

Video-based Assessment of Peripheral Intravenous Catheter Insertion in the Resuscitation Area of a Pediatric Emergency Department.

The objective was to describe the frequency of and factors associated with prolonged peripheral intravenous catheter (PIV) insertion in the resuscitation area of a pediatric emergency department (PED). Video-based study of a consecutive sample of nontrauma patients undergoing PIV insertion in the resuscitation area of a PED. Preexisting videos were the main data source. The primary outcome was patients with prolonged duration of PIV insertion (>90 seconds from start of first attempt to successful flush/blood draw). Logistic regression identified variables independently associated with prolonged PIV insertion. A total of 151 consecutive nontrauma patients underwent PIV insertion during a 2.5-month period. Sixty-nine patients (46%) had prolonged PIV insertion, including 14 for whom PED providers failed to insert PIVs. For patients with successful PIV insertion by PED providers, median duration was 48 seconds (interquartile range [IQR] = 23 to 295 seconds). Vascular access was ultimately achieved for 13 patients (93%) with initial insertion failure by the PED team (10 non-PED personnel, three intraosseous lines), with a median duration of 26.7 minutes (IQR = 19.9 to 34.2 minutes). Age ≤ 2 years (ORadj = 6.9; 95% confidence interval [CI] = 2.9 to 16.1) and musculoskeletal contractures (ORadj = 5.3; 95% CI = 1.6 to 17.2) were independently associated with prolonged PIV insertion. Prolonged PIV insertion is common in a PED resuscitation area. When PED providers could not insert a PIV, time to insertion was very long. Young patients and those with contractures were at particular risk for prolonged and failed PIV placement. When emergent vascular access is required, alternative approaches should be considered early for these patients.

Barriers and Facilitators to Intraosseous Access in Adult Resuscitations When Peripheral Intravenous Access Is Not Achievable

Studies suggest that intraosseous (IO) access is underutilized in adult resuscitations, despite recommendations from advanced trauma and cardiac life support guidelines. The objective was to determine factors associated with IO access use by physicians during adult resuscitations when intravenous (IV) access is not immediately achievable. This study was an online survey among physicians purposefully recruited from various clinical care areas at three teaching hospitals. Questions were generated from the qualitative results of 20 iterative interviews, verified for internal validity, and piloted. The interview guide was based on the constructs of the Theory of Planned Behavior (TPB), which elicits salient attitudes, social influences, and control beliefs that potentially influence intention to use IO access. Recruitment took place in September 2012 until reaching more than 100% of the required sample size (n = 200). Internal consistency was measured using Cronbach's alpha, and the effect of TPB constructs and specific beliefs were assessed with regression analyses. For the 205 respondents, the mean age was 35 years (range = 20 to 66 years), and 53.3% were male. Participants' departmental affiliations were 50.3% emergency medicine (EM), 16.9% internal medicine, 14.9% anesthesia, 10.8% general surgery, and 7.2% critical care. Residents comprised 60.7% of the sample, and 39.3% were attending physicians. Median intention to use IO access when IV is not immediately achievable was 4.67 (interquartile range [IQR] = 4 to 5) out of 5 (5 highest) and predicted by the following TPB constructs: attitudes (AdjCoefficients = 0.504; 95% confidence interval [CI] = 0.334 to 0.673), social influences (AdjCoefficients = 0.285; 95% CI = 0.172 to 0.398), and control beliefs (AdjCoefficients 0.217; 95% CI = 0.113 to 0.320). Physicians were more likely to use IO access if they believed that it provided rapid vascular access for delivering large volumes of fluids, could prevent delays in care, and was associated with a low complication rate. Conversely, the perception that nurses are not familiar or supportive of IO access and a lack of physician confidence regarding the appropriate indications for IO access were barriers to use. These data are an important step in the knowledge-to-action process, as they identify specific factors associated with physician use of IO access. Interventions addressing these actionable facilitators and barriers are likely to have a positive effect on increasing the appropriate physician use of this potentially life-saving technique in adult patients requiring emergent vascular access.

The role of routine chest radiography for detecting complications after central venous catheter insertion.

Chest radiographs are obtained routinely after central venous catheter (CVC) insertion in many institutions, although it consumes time and money. The purpose of this study was to evaluate the role of post-procedural chest X-ray in detecting complications of CVC insertion; we performed CVC insertion without using ultrasonography guidance. A total of 454 patients who required an emergency vascular access for hemodialysis between February 2008 and March 2010 were included in this study. In cases where three to five unsuccessful attempts were encountered to place the CVC or pierce the artery, we used another site for CVC placement or we placed the CVC under ultrasonographic guidance. Both the internal jugular and the subclavian veins were used as routes for catheter insertion. All the catheters were dual lumen and were inserted by the same vascular access surgeon. All the catheters were inserted using the same protocol. This protocol consists of five stages including position, percutaneous anesthesia, puncture, pull out and placement. Chest radiography was obtained after the procedure and patients were interviewed for the presence of any unusual symptoms. The X-rays were reviewed by a radiologist who was unaware of the patients' symptoms. Complications occurred in two patients who had unusual symptoms after the placement of the catheter. Although immediate postprocedural chest radiography is recommended for tip position confirmation, it should not be considered a reliable procedure for detecting complications in the absence of clinical symptoms. It is recommended to monitor patients after catheter insertion and perform delayed chest X-ray in the presence of any unusual symptoms.

Board 399 - Research Abstract LMA/IO Placement Versus ETT/UVC Placement during Simulation in New NRP Trainees (Submission #471)

Introduction/Background Endotracheal intubation is the preferred procedure taught in the Neonatal Resuscitation Program (NRP) when a secure airway is needed. Studies show that pediatric residents are successful only 21-62% of the time, often requiring multiple attempts and taking longer than recommended. The laryngeal mask airway (LMA) is an alternate device that can be used to provide a secure airway. The preferred procedure taught in NRP for obtaining emergency vascular access is umbilical venous catheter (UVC) placement. Studies have shown intraosseous (IO) insertion to require less skill and practice and take less time than UVC placement for emergency vascular access. Pediatric residents can take six times as long to place an emergency UVC compared to IO. The purpose of this study was to compare the success and time to establish a secure airway and emergency vascular access during simulated neonatal resuscitation using LMA/IO versus endotracheal tube (ETT)/UVC in new NRP trainees. Methods Seventeen fourth year medical students on a pediatric rotation were recruited. They completed NRP training two days prior to study participation. The participants viewed a video demonstration of the four skills (ETT, LMA, UVC and IO) and performed each procedure on a manikin or task trainer with guidance from an experienced NRP provider. The students then participated in a simulated delivery room scenario, where a secure airway and vascular access were needed. They were randomized to either LMA and IO or ETT and UVC. The scenarios were recorded for data collection and analysis. Data was also collected in real time by observers in the delivery room. After the delivery room scenario, the students were surveyed to assess experience and perceived confidence with each skill. Results Success of LMA placement was 100% versus 62.5% with ETT (p = 0.082). The median number of attempts was 1 for the LMA versus 2.5 for ETT (p = .009). The median total airway management time using LMA was 88 seconds versus 173 seconds with ETT (p < .001) and median procedure time of LMA insertion was 23 seconds, compared to 119 seconds for ETT (p = .015). The rate of success and median time to obtain vascular access using IO catheter versus UVC did not significant differ (both p > 0.4). Conclusion In this pilot study in a simulated delivery room setting, there was a statistically significant difference in the time to placement and number of attempts favoring LMA versus ETT. IO insertion was faster than UVC placement, although not statistically significant with the small sample size. If larger studies support our findings, NRP training may need to include LMA as the preferred method for a secure airway, particularly in those who do not routinely perform delivery room resuscitation. Disclosures None.

Evaluation of the sternal intraosseous route as alternative emergency vascular access for the dental office: a manikin and cadaver model pilot study

To evaluate 2 sternal intraosseous access devices as alternatives to emergency intravenous access for dentists, using a manikin and a cadaver model. A group of 37 students performed a sternal intraosseous access on a manikin using a Vidacare kit including a puncture template and a prepuncture skin incision. Five months later, 9 of the students used the Vidacare and 8 used an Illinois needle (without template and incision) on adult human cadavers. India ink was injected as a tracer. Shorter times were recorded on cadavers compared with manikins in both systems. One Vidacare puncture ended subcutaneously. Two Illinois needle punctures perforated the sternum, one with intense mediastinal ink traces. Vidacare punctures took longer compared with Illinois needle punctures (medians, 32 vs 12 seconds; P = .0002). Template use to identify the sternal puncture position, combined with additional prepuncture skin incision, may be more efficient and less predisposed to severe complications for dentists' emergency use.

Is intraosseous puncture an alternative emergency vascular access in dental practice?

Hintergrund An der Mehrzahl der zahnmedizinischen Fakultaten in Deutschland wird im Rahmen notfallmedizinischer Vorlesungen als Alternative zum periphervenosen („IV“) Zugang die intraossare („IO“) Punktion gelehrt. Ziel dieser Publikation ist es, innerhalb einer Gruppe von Studenten der Zahnmedizin am Modell drei unterschiedliche IO-Systeme zu vergleichen und der periphervenosen Punktion gegenuberzustellen.

Intraosseous Vascular Access for In-Hospital Emergency Use

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. 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. 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. 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. 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.

Systematic Evaluation of Vascular Access by Color‐Doppler Ultrasound Decreased the Incidence of Emergent Vascular Access Intervention Therapy and X‐Ray Exposure Time: A Single‐Center Observational Study

Arteriovenous fistula has superior patency over other accesses, but vascular access intervention therapy (VAIVT) for stenosis or thrombosis still remain major reasons for hospital admission of dialysis patients. The aim of this study was to examine the usefulness of systematic evaluation of vascular access by color-Doppler ultrasound (CDUS). This study was a single-center observational design study. We planned screening CDUS to evaluate all vascular accesses once per year, and additionally, follow-up CDUS of post-interventional patients 1 month, 3 months and 6 months after their recent VAIVT. This systematic evaluation was started from September 2009. The observational period between September 2008 and August 2009 was defined as period A. The observational period between September 2009 and August 2010 was defined as period B. We compared the incidence of emergent VAIVT and X-ray exposure time during the period A to B. 131 patients with AV fistula were assigned. 13 patients were excluded due to death, hospital transfer or re-operation of their accesses. During period A, 57 VAIVTs were carried out, and 37 cases (65%) were emergent. During period B, 42 VAIVTs were carried out, and 11 cases (25%) were emergent. The incidence of emergent intervention therapy was lower during period B than period A (P < 0.001). The amount of X-ray exposure time per patient was decreased in patients who received VAIVT during both periods (P < 0.03). Systematic evaluation of vascular access by CDUS decreased the incidence of emergent VAIVT and X-ray exposure time.

Recommendations for the Use of Intraosseous Vascular Access for Emergent and Nonemergent Situations in Various Health Care Settings: A Consensus Paper

In recognition of the value of intraosseous (IO) vascular access in patient resuscitation and stabilization, leading national and international organizations have published position papers that have served to change the standard of care for emergency vascular access. Among them are the American Heart Association (AHA) addressing vascular access in cardiac arrest patients ( American Heart Association, 2005a American Heart Association American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care: Part 7.2: Management of cardiac arrest. Circulation. 2005; : IV 58-IV 66 Google Scholar ), the International Liaison Committee on Resuscitation ( International Liaison Committee on Resuscitation (ILCOR), 2005 International Liaison Committee on Resuscitation (ILCOR) International consensus of cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Part 4: Advanced life support. Resuscitation. 2005; 67: 213-247 Abstract Full Text Full Text PDF PubMed Scopus (203) Google Scholar ), the European Resuscitation Council ( European Resuscitation Council, 2005 European Resuscitation Council European Resuscitation Guidelines. Resuscitation. 2005; 6751 (Accessed July 3, 2010): 51-52http://www.erc.edu/index.php Google Scholar ), the Infusion Nurses Society ( Infusion Nurses Society, 2009 Infusion Nurses SocietyThe role of the registered nurse in the insertion of intraosseous access devices. Journal of Infusion Nursing. 2009; 32 (position paper): 187-188 Crossref PubMed Scopus (11) Google Scholar ), the National Association of EMS Physicians ( Fowler et al., 2007 Fowler R. Gallagher J.D. Isaacs M.S. et al. The role of intraosseous vascular access in the out-of-hospital environment (resource document to the NAEMSP position statement). Prehospital Emergency Care. 2007; 11: 63-66 Crossref PubMed Scopus (91) Google Scholar ), with the Emergency Nurses Association (ENA) and the American Association of Critical-Care Nurses (AACN) endorsing the INS position paper ( American Association of Critical Care Nurses American Association of Critical Care Nurses American Association of Critical-Care Nurses endorses nurses' expanded role in use of IO access devices. http://www.aacn.org/WD/PressRoom Google Scholar , Emergency Nurses Association, 2009 Emergency Nurses Association ENA supported statements Published August. http://www.ena.orgDate: 2009 Google Scholar ). These professional societies recognized that IO access may provide significant time savings that could benefit patients in emergent situations by decreasing the time required to achieve access and the time required to administer necessary fluids and medications. The AHA concluded that intravenous (IV) and IO administrations have equal, predictable drug delivery and pharmacologic effects. Both AHA and the European Resuscitation Council guidelines state that IO access should be the first alternative to failed IV access ( American Heart Association, 2005a American Heart Association American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care: Part 7.2: Management of cardiac arrest. Circulation. 2005; : IV 58-IV 66 Google Scholar , International Liaison Committee on Resuscitation (ILCOR), 2005 International Liaison Committee on Resuscitation (ILCOR) International consensus of cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Part 4: Advanced life support. Resuscitation. 2005; 67: 213-247 Abstract Full Text Full Text PDF PubMed Scopus (203) Google Scholar ).

Recommendations for the Use of Intraosseous Vascular Access for Emergent and Nonemergent Situations in Various Healthcare Settings: A Consensus Paper

In recognition of the value of intraosseous (IO) vascular access in patient resuscitation and stabilization, leading national and international organizations have published position papers that have served to change the standard of care for emergency vascular access. Among them are the American Heart Association (AHA), addressing vascular access in cardiac arrest patients, 1 American Heart Association American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care: management of cardiac arrest. Circulation. 2005; : IV-58–IV-66 Google Scholar the International Committee on Resuscitation (ILCOR), 2 International Liaison Committee on Resuscitation (ILCOR) International consensus of cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations: advanced life support. Resuscitation. 2005; 67: 213-247 PubMed Google Scholar the European Resuscitation Council, 3 European Resuscitation Council European resuscitation guidelines. Resuscitation. 2005; 6751 (Accessed July 3, 2010): 51-52http://www.erc.edu/index.php Google Scholar the Infusion Nurses Society (INS), 4 Infusion Nurses Society [position paper] The role of the registered nurse in the insertion of intraosseous access devices. J Infus Nurs. 2009; 32: 187-188 Crossref PubMed Scopus (11) Google Scholar the National Association of EMS Physicians (NAEMSP), 5 Fowler R Gallagher JD Isaacs MS et al. [resource document to the NAEMSP position statement]. The role of intraosseous vascular access in the out-of-hospital environment. Prehosp Emerg Care. 2007; 11: 63-66 Crossref PubMed Scopus (92) Google Scholar with the Emergency Nurses Association (ENA) and the American Association of Critical-Care Nurses (AACN) endorsing the INS position paper. 6 Emergency Nurses Association ENA-supported statements. http://www.ena.org Google Scholar , 7 American Association of Critical-Care Nurses American Association of Critical-Care Nurses endorses nurses’ expanded role in use of IO access devices. http://www.aacn.org/WD/PressRoom Google Scholar These professional societies recognized that IO access may provide significant time savings that could benefit patients in emergent situations by decreasing the time required to achieve access and the time required to administer necessary fluids and medications. The AHA concluded that intravenous (IV) and IO administration have equal, predictable drug delivery and pharmacologic effects. Both AHA and European Resuscitation Council guidelines state that IO access should be the first alternative to failed IV access. 1 American Heart Association American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care: management of cardiac arrest. Circulation. 2005; : IV-58–IV-66 Google Scholar , 2 International Liaison Committee on Resuscitation (ILCOR) International consensus of cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations: advanced life support. Resuscitation. 2005; 67: 213-247 PubMed Google Scholar Lynn Phillips, Infusion Nurses Society and Consortium Chair. Lucinda Brown, Society of Pediatric Nurses. Teri Campbell, Air and Transport Nurses Association. Julie Miller, American Association of Critical-Care Nurses. Jean Proehl, Emergency Nurses Association. Barbara Youngberg, Visiting Professor of Health Law and Policy, Beazley Institute for Health Law and Policy, Loyola University Chicago College of Law.