Comparative Safety and Efficacy of Four Intraosseous Devices for Vascular Access in the Emergency Department: A Systematic Review and Network Meta-Analysis.
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引用次数: 0
Abstract
Background: Intraosseous (IO) devices are increasingly being utilized for rapid vascular access in emergency departments (ED) and other time-sensitive conditions where intravenous access is challenging. In spite of their growing use, there is a paucity of literature addressing their safety and efficacy profiles, and it is needed to guide their current status in clinical practice and policy.
Objectives: To compare the safety and efficacy of four different types of IO devices utilized in EDs: battery-powered drill, automatic, semi-automatic spring-loaded, and manual devices.
Methods: A systematic review and network meta-analysis was conducted. Studies on human subjects (excluding neonates) requiring IO access were included. Risk of bias and network meta-analysis was performed, with risk ratios (RR) and 95% confidence intervals (CI) calculated. Pairwise analysis of studies and surface under cumulative ranking curve (SUCRA) ranking of all devices were done.
Results: Ten studies (783 participants) were included. Battery-powered drill device (RR 1.30, 95% CI 1.10-1.54), followed by manual device (RR 1.27, 95% CI 0.99-1.62) and automatic device (RR 1.20, 95% CI 0.99-1.44), showed higher incidence of success rates when compared with semi-automatic spring-loaded device. The SUCRA ranking also showed the highest cumulative probability of battery-powered drill (RR 1.30, 95% CI 1.10-1.54). Safety data were pooled in a tabular form.
Conclusion: This meta-analysis provides insights that, although battery-powered drill device showed the best outcomes, the wide confidence intervals and lack of statistically significant differences between devices highlight the need for further research with larger sample sizes and standardized safety reporting protocols, to establish conclusions regarding optimal IO device for EDs.
Research question: What are the comparative safety and efficacy profiles of four different intraosseous devices, that is, battery-powered drill device, automatic device, semi-automatic spring-loaded device, and manual device, used for vascular access during resuscitation in the ED?
期刊介绍：
The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections:
• Original Contributions
• Clinical Communications: Pediatric, Adult, OB/GYN
• Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care
• Techniques and Procedures
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• Violence: Recognition, Management, and Prevention
• Ethics
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• American Academy of Emergency Medicine
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• Book and Other Media Reviews
• Calendar of Events
• Abstracts
• Trauma Reports
• Ultrasound in Emergency Medicine
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