Drumheller BC, Edgar MD, Tape MK, Vongviphut D, Herres JP. Comparison of the NIO and EZIO for Resuscitative Vascular Access in the Emergency Department: A Quasi-Experimental, Before-and-After Study.
Mil Med 2023;
188:3423-3431. [PMID:
35870113 DOI:
10.1093/milmed/usac126]
[Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/22/2022] [Accepted: 04/18/2022] [Indexed: 11/09/2023] Open
Abstract
INTRODUCTION
Intraosseous (IO) needle insertion is a key adjunctive procedure in the care of critically ill and injured patients in a variety of settings, including the battlefield. The NIO is a new, fully disposable, single-piece, IO device with potential practical advantages under austere conditions. We sought to compare the efficacy and safety of the NIO to an established, well-studied device, the EZIO, when used for resuscitative vascular access in the emergency department (ED).
METHODS
Retrospective, single-center, quasi-experimental, before-and-after, observational cohort study performed at an urban, tertiary-care hospital ED among adult patients receiving IO access during resuscitation. The before/NIO period lasted from July 1, 2019, to May 31, 2020, and the EZIO/after period from June 1, 2020, to April 30, 2021. Patient demographics, prehospital treatment, ED presentation, characteristics and results of IO insertion(s), potential procedure-associated adverse events, and ED and hospital outcomes were abstracted from the medical record. The primary outcome, rate of first-pass success (FPS), was compared between the NIO and EZIO periods using multivariable regression after adjustment for potential confounding factors.
RESULTS
We enrolled 63 total patients/66 limbs (mean age 61 ± 18, 51% female), 34 patients/35 limbs during the NIO period and 29 patients/31 limbs during the EZIO period. The most common reason for IO insertion was cardiac arrest (40/63, 63%), followed by respiratory failure, trauma, and sepsis. The majority of IO insertions were performed at the proximal tibia (58/66, 88%) by senior emergency medicine residents or faculty. The overall rate of FPS was 53/66 (80%), 24/35 (69%) with the NIO compared to 29/31 (94%) with the EZIO. After multivariable modeling, the odds of FPS with the NIO vs. the EZIO was 0.19 (95% CI, 0.01-1.5, P = .16). Procedure-related adverse events were infrequent in both groups. In-hospital mortality was 45/63 (71%).
CONCLUSIONS
We found that the NIO device was associated with a lower-than-expected rate of FPS compared to the EZIO device, although not significantly different after adjusting for between-group imbalances and considering limitations in the study design. Further, prospective research into the efficacy and safety of the NIO is needed before clinical use can be encouraged.
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