Intraosseous vascular access in emergency and trauma settings: a comparison of the most universally used intraosseous devices

ABSTRACT

Introduction: Obtaining successful vascular access is an essential component of the emergency and trauma setting. The modern practice of medicine advocates IO access for patients in a critical condition, especially when IV access is problematic or unobtainable. Various medical devices allowing for IO access have been coined and used in the management of critical patients.

Areas covered: This study aims to review the literature regarding different intraosseous devices used to obtain vascular access (Bone Injection Gun (BIG), EZ-IO, NIO, Jamshidi, and First Access for Shock and Trauma (FAST-1) and discuss their clinical and experimental role in the emergency and trauma settings.

Expert opinion: The development of medical technology contributes to an increasing number of intraosseous devices facilitating vascular access in challenging scenarios, including cardiopulmonary resuscitation, anaphylactic, or hypovolemic shock. Each of these devices provides an effective route for fluid resuscitation, drug delivery, laboratory evaluation, and shortening the timeframe for established vascular access, provided that the person obtaining the access is acquainted with the use of the device.

KEYWORDS:

• Vascular access
• intravascular
• intraosseous device
• emergency medicine
• trauma setting

Article highlights

• Intraosseous access is an alternative method for pharmacotherapy or fluid administration and establishing vascular access in life-threatening conditions.

• Vascular access via an intraosseous device previously reserved for critical care conditions in pediatrics and the military is recommended for adult emergency and trauma conditions.

• Bone Injection Gun (BIG), its successor New Intraosseous Device (NIO), the Jamshidi, Easy Intraosseous Access Device (EZ-IO), or the FAST1 device are the most popular and widely used intraosseous devices for vascular access in emergency and trauma settings.

• Manual intraosseous devices (Jamshidi) are limited to the pediatric population in critical conditions or trauma.

• Semi-automatic intraosseous (BIG, NIO, and FAST-1) device systems are the most commonly used vascular access method due to their safety profile and ease of use.

• Drill intraosseous devices (EZ-IO) are user-friendly with limited training time.

• There are many types of intraosseous devices currently available on the market.

• Intraosseous devices may contribute to a decreased number of failed vascular access attempts, particularly during cardiopulmonary resuscitation or in life-threatening conditions.

• The learning curve for obtaining vascular access via an intraosseous device is shallow.

Acknowledgments

The paper was supported by the ERC Research Net and the Polish Society of Disaster Medicine.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.