Efficacy and Safety of the Intraosseous Vascular Access in out-of-Hospital Emergencies: A Prospective Study of the Pre-Hospital Emergency Service (SUEM 118) of Padua from 2012 to Today

Abstract

Background: Several scientific associations recommend the use of the intraosseous access as a valid alternative to the intravenous route, which is often difficult to find in emergency conditions, as a safe and effective way for drugs and fluids administration and for blood sampling. Aim of the study: The purpose of this study was the evaluation of the use of the EZ-IO® device, by the S.U.E.M. 118 of Padua, in terms of efficacy and safety in obtaining intraosseous vascular access for fluids and drugs infusions in an out-of-hospital emergency setting. Materials and methods: From February 2012 to May 2016, all cases of pre-hospital IO access within the operational areas of the Pre-hospital Emergency Service (SUEM 118) of Padua were prospectively recorded. Data were collected by using a standardized grid and by consulting the online computer server Galileo. Data were then analysed by using the Statgraphics Centurion and Microsoft® Excel software. Results: 89 patients required an intraosseous vascular access. Needles’ placement using the EZ-IO device was successful in 97.75% (87/89). Considering only first attempts, the success rate is 95.51% (85/89). No immediate complications were observed. After one year, one patient was found to have an abscess at the insertion site, but there are insufficient data to establish the cause. Pain was evaluated in 38 patients, after administration of Lidocaine and the Mean value was calculated to be 3 and standard deviation (sd) 2. Only one patient reported unbearable pain (10/10). Conclusions: The high percentage of successful insertions along with low complication rates, shows that the use of intraosseous vascular access should be considered as first line treatment in out-of-hospital emergencies, whenever a rapid and safe vascular access is required, thus it can be used in every situation where a vascular access is impossible to obtain, regardless of the clinical conditions of the patient and the elapsed time.