Current status of establishing a venous line in CPA patients by Emergency Life-Saving Technicians in the prehospital setting in Japan and a proposal for intraosseous infusion

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

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.

[Paediatric Life Support]

The European Resuscitation Council (ERC) Paediatric Life Support (PLS) guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations of the International Liaison Committee on Resuscitation (ILCOR). This section provides guidelines on the management of critically ill or injured infants, children and adolescents before, during and after respiratory/cardiac arrest.

European Resuscitation Council Guidelines 2021: Paediatric Life Support

These European Resuscitation Council Paediatric Life Support (PLS) guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the management of critically ill infants and children, before, during and after cardiac arrest.

Usefulness and Problems of Intraosseous Infusion with the Bone Injection Gun™ Using Simulators Under Confined Space Conditions

Introduction

It is important to have a venous line for infusion as an emergency treatment for patients suffering from crush syndrome or bleeding under confined space (CS) conditions in disaster medicine. However, it is not easy to for Emergency Life-Saving Technicians (ELSTs) to establish a venous line in such settings. Although previous studies have described the use of mechanical intraosseous (IO) devices and IO access while wearing chemical protection gears, problems for the use of IO devices under CS conditions have not been considered. This study aimed to investigate usefulness and problems of using a Bone Injection Gun™ (BIG) for IO infusion by ELSTs and rescue workers in CS conditions.

Methods

The time required and success rate for IO infusion using a BIG in a manikin leg were measured, and for administering intravenous infusion in a manikin arm using either rescue gloves or plastic gloves by ELSTs or rescue workers under CS conditions.

Results

Wearing rescue gloves, ELSTs were significantly faster in placing intraosseous infusion (IOI) compared with rescue workers. The success rate of the placement was not significantly different between ELSTs and rescue workers whether or not they wore rescue or plastic gloves.

Conclusions

Although the finite usefulness of IOI with BIG under CS conditions is indicated, some problems such as the timing of removal of the IOI and difficulty in finding the location of the trocar needle after activating BIG are pointed out. Therefore, there are rooms to consider using IOI with BIG under CS condition. (Hong Kong j.emerg. med. 2014;21:23-30)

Appearance Time of Methylene Blue in the Aorta: Intra-osseous vs Peripheral Intravenous Route

Background:

The intra-osseous (IO) route serves as an appropriate venous access site if access is needed in an emergency.

Objectives:

In this study, we compared the appearance time of methylene blue (MB) in the aorta following IO and peripheral intravenous (IV) routes in a rabbit model to assess a novel idea and compare the speed of IV and IO route of serum delivery into the main circulation.

Materials and Methods:

Twenty rabbits were used in our study. They were divided into two groups (odds as G1, n=10, evens as G2, n=10). After laparotomy, the aorta was located and cannulated by a 16 gauge angiocatheter. For IV injection in GII, the marginal vein of either ear was accessed. For IO injection in G1, the medial surface of the proximal extremity of left tibia was used. Once satisfied with positioning, 10 ml of methylene blue solution at a concentration of 10 mg /ml was injected and the time was recorded. The time taken from injection to appearance of MB in the aorta was measured.

Results:

All rabbits survived until the end of the experiment. There was no significant difference between the groups regarding the body weight. There was no significant difference between mean time of dye entry into the aorta in either group. It was 9.66 ± 2.51 seconds in G1 and 10.24 ± 1.95 seconds in G2 (P = 0.56).

Conclusions:

Our study demonstrated that there was no significant difference between the time taken for MB to reach the central circulation via IO or IV routes.