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Int. Rev. Allergol. Clin. Immunol. Family Med., 2019, XXV/1: 013-018 Maximize

Int. Rev. Allergol. Clin. Immunol. Family Med., 2019, XXV/1: 013-018

Title: Intraosseous route as a method of intravascular access in life-threatening conditions. Randomized cross-over study 

Authors: Drozd A, Smereka J, Bialka S, Bielski K, Szarpak L. 

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02-01-2019

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SUMMARY IN POLISH & ENGLISH. FULL ARTICLE ONLY IN ENGLISH.

Intraosseous route as a method of intravascular access in life-threatening conditions.


Randomized cross-over study

Drozd A1, Smereka J2, Bialka S3, Bielski K4,5, Szarpak L4.

1Polish Society for Disaster Medicine, Warsaw, Poland; 2Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland; 3Department of Anesthesiology, Intensive Care and Emergency Medicine, Faculty of Medicine in Zabrze, Medical University of Silesia in Katowice, Poland; 4Medical Faculty of Lazarski University, Warsaw, Poland; 5Regional Emergency Medical System and Sanitary Transportation Station SPZOZ „Meditrans”, Warsaw, Poland

International Review of Medical Practice, 2019; Vol. 25, No. 1, 013

The provision of vascular access and the implementation of pharmacology and fluid therapy are key elements of emergency management, in this case the patient in hypovolemic shock. The willingness to obtain intravenous access if the vascular bed collapses may result in a prolonged procedure or be completely unfeasible. It may be helpful to use intraosseous access as an alternative to intravenous access.
Aim of the study
was to compare the effectiveness of obtaining intravenous and intraosseous access under the conditions of simulated hypovolemic shock by novice physicians.
Material and methods
. The study was designed as a randomized, cross-over prospective simulation study. The study involved 39 novice physicians, who performed intravenous and intravenous access under conditions of simulated hypovolemic shock. Time parameters were analyzed from grasping the intravenous cannula or intraosseous device to the moment of establishing vascular access (T1 time), to the moment of confirming the correctness of the injection with the syringe connection and aspiration test (T2 time) and to the moment of infusion line connection (T3 time). In addition, the ease of carrying out the procedure was assessed using a 10-degree audiovisual scale, in which 1 meant an easy and 10 a difficult to carry out procedure. In addition, the participants’ preferences regarding the use of particular procedures in the clinical conditions of rescue operations were assessed.
Results
. T1 time in the study group was differentiated between intraosseous and intravenous and was 7 (IQR; 6-12) and 35 (IQR; 22-41; p<0.001), respectively. For T2 time the difference was 15 (IQR; 12-22)s and 43 (IQR; 30-51)s (p<0.001), respectively. T3 time was 33 (IQR; 30-45)s and 66 (IQR; 43-79)s respectively. The ease of intraosseous and intravenous access was differentiated and in the case of intraosseous access was 2 (IQR; 2-4) points, and in the case of intravenous access – 6 (IQR; 5-8) points (p<0.001). 92.3% of all participants would choose intraosseous access as the preferred method of vascular access in real rescue procedures.
Conclusions
. In the opinion of the participants, intraosseous access is an easier method of obtaining vascular access in comparison with intravenous access. Intraosseous access in comparison with intravenous cannula was associated with shorter time of obtaining vascular access and shorter time of fluid therapy implementation.

Key words: intraosseous access, physician, medical simulation, emergency, hypovolemic shock